uncompensated. In the first decade of EMTALA, such cost-shifting amounted to a hidden tax levied by providers. For example, it has been estimated that this cost shifting amounted to $455 per individual or $1,186 per family in California each year. However, because of the recent influence of managed care and other cost control initiatives by insurance companies, hospitals are less able to shift costs, and end up writing off more in uncompensated care. The amount of uncompensated care delivered by non-federal community hospitals grew from $6.1 billion in 1983 to $40.7 billion in 2004, according to a 2004 report from the Kaiser Commission on Medicaid and the Uninsured, but it is unclear what percentage of this was emergency care and therefore attributable to EMTALA. Financial pressures on hospitals in the 20 years since EMTALA's passage have caused them to consolidate and close facilities, contributing to emergency department overcrowding. According to the Institute of Medicine, between 1993 and 2003, emergency departments visits in the U.S. grew by 26 percent, while in the same period, the number of emergency departments declined by 425. Ambulance are frequently diverted from overcrowded emergency departments to other hospitals that may be farther away. In 2003, ambulances were diverted over a half a million times, not necessarily due to patients' inability to pay. Emergency abortions After Roe v. Wade was overturned in June 2022, transforming the legal landscape for abortion in the United States, the HHS clarified that EMTALA protections for clinicians apply regardless of state laws. See also Health care in the United States Notes and references External links CMS EMTALA overview from hhs.gov State Operations Manual from hhs.gov EMTALA: Its Application to Newborn Infants, by Thaddeus M. Pope, ABA Health eSource, Vol. 4, No. 7 (March 2008) 1986 in American law 99th United States Congress Medicare and Medicaid (United States) Emergency medical services in the United States United States federal health legislation