I almost want to disagree with you here but I’m not fully apprised of the greater situation.
My dad is poor and neglectful of himself. He had a stroke. He got ambulanced to the emergency room and spent a good deal of time there.
The hospital discussed billing which was several hundreds of thousands of dollars. Well he can’t afford that. The hospital had us talk to some advisers and they got him on a state Medicaid (?) plan. The plan retroactively paid for it all.
He then got checked out for a variety of other issues including a severe spinal issue and a hip replacement for 0 out of pocket.
It’s great. He’s a changed man who is active and takes care of himself now.
I also had a major medical event and I have since paid tens of thousands out of pocket after insurance. At one point we were investigating if I could essentially quit work for a bit, go on the Medicaid plan, get better, and then go back to my job. That is madness!
States that opted into the ACA Medicaid Expansion and generally fund hospitals have great emergency care for poor people. There's a kind of missing middle where once you're above the income threshold for Medicaid but aren't working for a job that's willing to fund an extremely good health plan you have to deal with all sorts of deductibles and prior authorizations and stuff. Plus, non-emergency care, especially from specialists, has gotten longer and longer wait times unless you're lucky enough to live in a region with mostly healthy people that also aren't the "worried well."
Tl;dr, it's incredibly patchwork, and everyone's experience is going to vary depending on their state's individual social safety net, the overall health of their local population, the particular insurance network and hospital network they have access to, and their individual income.
Also, the US has a federal law that no hospital that accepts Medicare patients is allowed to deny care in the case of an emergency based on someone's ability to pay. That means that a lot of very poor people will get incredibly expensive emergency care for free, while not being able to afford the basic preventative care that would keep them out of a state of medical emergency. That isn't really the hallmark of a particularly functional system.
You have rights in an emergency room under EMTALA
Doctor talking to a patient
You have these protections:
1. An appropriate medical screening exam to check for an emergency medical condition, and if you have one,
2. Treatment until your emergency medical condition is stabilized, or
3. An appropriate transfer to another hospital if you need it
The law that gives everyone in the U.S. these protections is the Emergency Medical Treatment and Labor Act, also known as "EMTALA." This law helps prevent any hospital emergency department that receives Medicare funds (which includes most U.S. hospitals) from refusing to treat patients.
A lack of care for those who can't afford it is, though.