In 1986 the federal government enacted a statute, the Consolidated Omnibus Budget Reconciliation Act (COBRA), intended to address the perceived problem of patients being denied essential emergency medical care, or being transferred in an unstable condition, because of the patient's lack of an adequate payer source. Compliance with COBRA has been a concern among hospitals and emergency physicians (EPs). Indeed, by the end of 1993, the federal government investigated > 1,500 allegations of COBRA violations. Since COBRA was enacted to address the problem of "economically motivated" transfers of indigent patients, many EPs are unaware of the potential for COBRA violations inherent in the accommodations currently being sought by some managed care organizations. This paper reviews hospitals' and physicians' obligations to managed care patients under COBRA.