Hard to believe it’s been 25 years. In the spring of 1986, I was still pondering my top two career choices: medicine and civil engineering, anxiously awaiting an eventual scholarship to my undergraduate institution, and just simply trying to make the most of waning days of carefree bliss as a senior high school student. All the while, there were changes afoot in healthcare — changes that would eventually affect me and my chosen career path. It all had to do with the way the healthcare system was treating its poorest patients, fundamentally shifting policies that are really taken for granted today in the grand scheme of 21st century reform. The Emergency Medical Treatment and Active Labor Act (EMTALA) was passed as part of a larger bill — the Omnibus Budget Reconciliation Act — that year. It was a non-discrimination statute designed to guarantee patient stabilization in emergency medical cases regardless of the patient’s ability to pay and to prevent involuntary patient transfers for financial concerns and not via medical protocols (patient dumping). Little did Congress know at the time, that this law placed the onus of care coordination in emergent situations on hospitals — which had no choice but to develop policies that would have to contain costs for such guaranteed care. Because of this legislation, healthcare providers had a responsibility to provide for the system’s sickest patients. States had no choice but to formulate solutions to a growing crisis in care delivery. EMTALA legislation set the stage for major changes in Medicare and Medicaid policy — not to mention exposing massive pitfalls in medicolegal scenarios paving the way for future discussions on tort reform as it applied to controlling healthcare costs in individual states. There is no doubt that the core principles behind EMTALA provide a framework for the president’s initiatives on healthcare delivery — that all citizens are guaranteed care regardless of the ability to pay. The challenge for proponents of reform and the ACA in its entirety is to build upon that notion while supporting business models that guarantee supply of such care –something much easier said than done at this point in the timeline of U.S. healthcare policy.