The EMTLA passed in 1986 was a compromise Reagan made with the Democrats to get what he wanted.  It requires all hospitals getting any form of federal compensation to treat all emergencies regardless of ability to pay.  They do get a bill, but most of those bills don't get paid, and are often discharged in bankruptcy.  There is no federal reimbursement to the hospitals for these costs, so the government looks the other way when hospitals "cost shift" by padding the charges to people who have insurance, a major contributor to rising health care costs.  Most of the people in the crowded ERs are indigents getting, effectively, free health care.