Medicaid Expansion Drives up Visits to Emergency Room

From NCPA January 6, 2014

Some supporters of President Barack Obama's health care overhaul say that putting uninsured Americans on Medicaid will reduce costly emergency room (ER) visits by giving them more access to care in other settings. But a new study found the reverse: A group of 10,000 low-income Oregon residents who recently obtained Medicaid coverage visited ERs 40 percent more often than those without insurance, says the Wall Street Journal.

The new Medicaid recipients used ERs more often for all kinds of health issues, including problems that could have been treated in doctors' offices during business hours, according to the study published in the journal Science. Earlier studies had found the same patients used more of other medical services as well.

• On average, the Medicaid recipients visited ERs in 12 Portland-area hospitals 1.4 times during an 18-month period, compared with 1.02 visits for the control group without insurance.
• Using $435 as the average cost of an ER visit, the researchers calculated that Medicaid increased annual ER spending by $120 a covered person.
• Hospitals often end up footing the bill for uninsured patients.

States are sharply divided by Medicaid expansion, the one part of the 2010 health care law that the Supreme Court ruled optional in 2012.

• To date, 25 states and the District of Columbia have accepted the Obama administration's offer to finance extending the Medicaid program to anyone earning less than 138 percent of the federal poverty level through 2016, and to finance 90 percent of the costs thereafter.
• Other states, mostly led by Republican governors, have declined the offer, citing their opposition to the health care overhaul and cost concerns.

Since October, nearly 4 million Americans have applied for Medicaid in the expansion states, according to federal figures, and some hospitals are bracing for an increase in patients. More than 72 million people -- roughly 20 percent of the U.S. population -- were covered by Medicaid for at least one month in 2012.

Critics of the health care overhaul said the study's findings confirmed their view that Medicaid expansion would cost more, not less.

Source: Melinda Beck, "Medicaid Expansion Drives up Visits to ER," Wall Street Journal, January 2, 2014.