Health News

Medicaid expansion does not increase ER use, study says

People without health insurance have typically gone to the emergency room when sick or injured because they will be treated regardless of their ability to pay.

While the number of people using the ER for health treatment was expected to increase with the expansion of Medicaid, researchers at George Washington University report not only that the number of ER patients has remained steady but that more of them can pay for services because they got Medicaid.

Researchers say ER use was expected to increase for two reasons: because people with health insurance tend to use more healthcare than those without it, and because Medicaid beneficiaries often use the ER more because it can be difficult to see a doctor.

The reality, researchers report, is that no such surge in patients has been seen, and uninsured ER visits have dropped by nearly one-third, improving the economic situation for emergency medical services.

“With no increase in emergency department visit rates, our research is good news for government programs aimed at expanding health insurance, and in particular Medicaid coverage,” Dr. Jesse Pines, a professor at the George Washington University’s School of Medicine, said in a press release. “We challenge the conventional wisdom that people go to the emergency department because they do or don’t have health insurance. People use the emergency department when they’re sick or injured. That’s why we stay open.”

For the study, published in the journal Health Affairs, researchers analyzed data on emergency room use at 478 hospitals in 36 states during 2014, the first year the Affordable Care Act’s expansions to Medicaid went into effect.

The researchers found Medicaid-paid ER visits increased by 27.1 percent, while uninsured visits went down by 31.4 percent and privately-insured visits dropped by 6.7 percent in states that expanded Medicaid, compared to states that did not expand the program.

The number of ER visits grew by less than 3 percent in 2014, and there was not a big difference between states that did and did not expand Medicaid.

“Improving the percentage of previously uninsured patients has an important impact on the economics of emergency services — in this case, improving the payer mix with higher percentages of Medicaid patients,” said Dr. Randy Pilgrim, chief medical officer at Schumacher Clinical Partners, a multi-specialty physician management group whose data, along with data from two other companies, was used for the study. “Payments for Medicaid visits are higher than for the uninsured. But the long term impact of the ACA on the overall economics of emergency care is still an open question, especially with other provisions that affect reimbursement, including the future effect of new payment models.”