For 26 years, the Emergency Medical Treatment and Active Labor Act, or EMTALA, has been a bedrock principle of American healthcare ? passed by a bipartisan Congress, signed by a Republican president and largely unchallenged since by hospitals and doctors. "Whether people know it or not, whether people appreciate it or not, access to emergency care became a right in this country in 1986," said Dr. Wesley Fields, an emergency room physician in Orange County. "But the law that did that never addressed the big question of whose responsibility it was to deal with the cost." That unresolved question ? who pays? ? helped shape President Obama's 2010 healthcare law and its requirement that Americans get health insurance.