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Photo: Aaron P. Bernstein/Getty Images

Emergency-room doctors in Georgia are suing Anthem over its policy of not paying for ER visits it deems unnecessary. They say the policy violates the Affordable Care Act, as well as other federal laws and even civil rights protections.

The issue: Anthem has told its customers in six states that it will no longer be paying for trips to the emergency room for conditions that aren’t an emergency.

  • But Anthem is deciding what constitutes an emergency based on the ultimate diagnosis, rather than the patient’s symptoms.
  • Patients who are in some form of pain often aren’t qualified to diagnose themselves and decide whether to go to the ER or wait for an urgent care clinic.
  • Federal law defines an “emergency medical condition” as one that a “prudent layperson” would think it needs immediate attention, and it requires ERs to treat everyone who comes through the door.

What they’re saying: Georgia ER doctors say Anthem violated those requirements by using a different standard and because of the way it discouraged patients from relying on the ER.

  • The policy also “forces providers to question the ultimate diagnosis prescribed to a patient, in spite of their presenting symptoms, as the ultimate indicator of whether payment will be made,” the lawsuit states.

Why it matters: This back-and-forth is a good example of why health care is so hard.

  • Yes, it costs the system a lot of money for patients to go to the ER when they don't need to.
  • People with insurance don't want to pay the resulting higher premiums, but they do want access to care even when they are not able to correctly diagnose their own conditions.
  • Providers are trying to get paid, and insurers are trying not to pay them — a tale as old as time.

Go deeper

Trump grants flurry of last-minute pardons

Photo: Jabin Botsford/The Washington Post via Getty

President Trump issued 73 pardons and commuted the sentences of 70 individuals early Wednesday, 11 hours from leaving office.

Why it matters: It's a last-minute gift to some of the president's loyalists and an evident use of executive power with only hours left of his presidency. Axios reported in December that Trump planned to grant pardons to "every person who ever talked to me."

2 hours ago - Politics & Policy

Trump revokes ethics order barring former aides from lobbying

Photo: Spencer Platt via Getty

Shortly after pardoning members of Congress and lobbyists convicted on corruption charges, President Trump revoked an executive order barring former officials from lobbying for five years after leaving his administration.

Why it matters: The order, which was signed eight days after he took office, was an attempt to fulfill his campaign promise to "drain the swamp."

  • But with less than 12 hours left in office, Trump has now removed those limitations on his own aides.

Trump pardons former GOP fundraiser Elliott Broidy

President Trump has pardoned Elliott Broidy, a former top Republican fundraiser who pleaded guilty late last year to conspiring to violate foreign lobbying laws as part of a campaign to sway the administration on behalf of Chinese and Malaysian interests.

Why it matters: Broidy was a deputy finance chair for the Republican National Committee early in Trump’s presidency, and attempted to leverage his influence in the Trump administration on behalf of his clients. The president's decision to pardon Broidy represents one last favor for a prominent political ally.