Emergency Docs Say Sebelius is Wrong About ED

He adds that emergency room doctors also want patients to have health insurance.

"But even with primary care being all beefed up, patients will still be getting sick and injured, and they will still be coming to the emergency room."

Jouriles, whose association has been at odds with the Obama administration, in part for not inviting its representatives to health reform summits, says that even when there are enough primary care doctors, and even if emergent patients call them first, their doctors will just tell them to go to the emergency room anyway.

"It doesn't make sense to put resources into that phone call. You need to put resources into the emergency department," Jouriles says.

Right now, resource-starved emergency rooms are struggling to comply with EMTALA (Emergency Medical Treatment and Active Labor Act), which requires Medicare-eligible hospitals to treat all emergent patients who come through their doors until they're stable, regardless of their ability to pay the bill.

"There's no funding for that," he says. "Hospitals can't run a business. And from a patient's point of view, if there are less resources, the longer they will wait, and if you're having a heart attack or are in an accident, you're not going to be seen as quickly as possible."

A new court ruling also may pave the way for some insurance companies to avoid paying emergency doctors or hospitals for care given to their enrollees by out-of-network providers, Jouriles says.

Sources of funds, such as disproportionate share money, doesn't come close to covering the gap, which gets wider as more people lose their jobs and as employers increasingly opt out of purchasing health plans for their employees.

Jouriles says there are 1 billion doctor visits in the U.S. every year, and of those, 120 million, or 12%, occur in an emergency room. Yet only 4% of the nation's doctors are emergency specialists. "You can do the math and see that 4% of the physician workforce is providing more uncompensated care than the other 96% put together."

Sebelius is right on one thing, he says. "She's right that we need to do something about uncompensated care, but we need to put the resources where the patients are, the nation's emergency room, and in 4% of the physician workforce."