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Research & Commentary: Emergency Department Visits Increase Despite Obamacare Reforms

September 16, 2019

In this Research & Commentary, Matthew Glans examines a recent study from the Brookings Institution that found that emergency department use has continued to rise since the passage of the Affordable Care Act.

Although Obamacare was supposed to decrease unnecessary, costly emergency department (ED) visits, the exact opposite has happened. Many low-income patients continue to routinely use expensive ED services. This places significant pressure on ED staff and facilities. It also increases health care costs across the board, which Obamacare was also supposed to address.

Obamacare architects argued that if all Americans had health insurance, they would use primary care services instead of the ED for non-emergency services. However, since Obamacare became law, ED visits by low-income patients has increased, according to a recent study by the Brookings Institution.

The Brookings study, released in September, found Medicaid expansion has driven more patients to EDs for non-urgent conditions. The authors examined the number of Medicaid patients who sought ED services after Medicaid was expanded under Obamacare, where those visits occurred, and at what levels. The results showed, “patients visited hospitals 20% more than they did before they got coverage, and they mostly opted for emergency departments.”

The authors of the Brookings study argue this result isn’t surprising because of the emergency care mandate on hospitals known as the Emergency Medical Treatment and Active Labor Act (EMTALA). Under EMTALA, emergency departments are required to medically screen every patient seeking emergency care and to stabilize or transfer those with medical emergencies, regardless of health insurance status or ability to pay.

These results echo the findings of several other studies on post-Obamacare ED data. According to a 2015 survey of members of the American College of Emergency Physicians (ACEP), the number of emergency room visits by low-income patients increased since Obamacare went into effect.

The ACEP study found noticeable increases in the number of people seeking ED care. In fact, more than 75 percent of the 2,099 doctors surveyed said they witnessed more patients using ED services. Forty-seven percent said they saw a slight increase and 28 percent reported a large increase. Fifty-six percent experienced an increase in the number of Medicaid patients using emergency rooms. Eighty-six percent of the doctors surveyed reported the severity of the illness or injury among emergency room patients either increased or remained the same since Obamacare became the law of the land.

One of the stated goals of Obamacare was to reduce the number of uninsured patients using the nation’s emergency rooms for non-emergency services. Unfortunately, the total opposite has occurred.

The following documents provide additional information about the Obamacare and its effects on emergency room visits.
 

All Medicaid Expansions Are Not Created Equal: The Geography and Targeting of the Affordable Care Act
https://www.brookings.edu/wp-content/uploads/2019/09/Garthwaite-et-al_conference-draft.pdf
This article from the Brookings Institution uses comprehensive patient-level discharge data to study the effect of Medicaid on the use of hospital services.

Effect of Medicaid Coverage on ED Use — Further Evidence from Oregon’s Experiment
http://www.nejm.org/doi/pdf/10.1056/NEJMp1609533
Heidi Allen, Katherine Baicker, Amy Finkelstein, Sarah Taubman, and Bill Wright examine the effect of Medicaid coverage on ED use, in which they found people enrolled in Medicaid significantly increase their emergency room visits for around two years after they first sign up.

Medicaid Expansion Causes Surge In ER Visits
http://www.forbes.com/sites/theapothecary/2016/10/20/medicaid-expansion-causes-surge-in-er-visits/#5845ac497b0d
Brian Blase writes in Forbes about a study in the New England Journal of Medicine which uses the Oregon Medicaid experiment to track the effect of expansion on ER visits. “From the Oregon Medicaid experiment, we know that Medicaid expansion does not seem to produce better physical health outcomes, that expansion enrollees receive low benefit relative to the cost, and that ER use surges,” Blase wrote.

Medicaid Increases Emergency-Department Use: Evidence from Oregon's Health Insurance Experiment
https://www.heartland.org/publications-resources/publications/medicaid-increases-emergency-department-use-evidence-from-oregons-health-insurance-experiment
Heidi Allen, Katherine Baicker, Amy Finkelstein, Sarah Taubman, and Bill Wright use the Oregon Health Insurance experiment to study the emergency department use of about 25,000 lottery participants over about 18 months after the lottery. The authors found “Medicaid coverage significantly increases overall emergency use by 0.41 visits per person, or 40% relative to an average of 1.02 visits per person in the control group.”

Surge in Emergency Department Use Persists in New Oregon Medicaid Study
http://www.cato.org/blog/surge-emergency-department-use-persists-new-oregon-medicaid-study
Charles Hughes of the Cato Institute examines the results of the NEJM ER visit study and discusses how the results undermine the arguments in favor of Medicaid expansion. “This new study confirms that these effects were not temporary and do not dissipate, at least over the two year period they were able to analyze. Expanding Medicaid coverage will not lead to reductions in inefficient, inexpensive emergency department visits, and there will be no associated cost savings, undermining one of the common fiscal arguments for expansion,” wrote Hughes.

Ten Principles of Health Care Policy
https://www.heartland.org/publications-resources/publications/ten-principles-of-health-care-policy 
This pamphlet in The Heartland Institute’s Legislative Principles series describes the proper role of government in financing and delivering health care and provides reform suggestions to remedy current health care policy problems.

The Obamacare Disaster
https://www.heartland.org/publications-resources/publications/the-obamacare-disaster
This Heartland Institute study by Peter Ferrara is a comprehensive review of the Affordable Care Act (ACA) and an early appraisal of its likely effects. “Obamacare is a disaster,” wrote Ferrara. “Rather than liberate the American health care system from bureaucracy and waste, it blankets it with more of both, suffocating innovation and destroying freedom. The result is a system that is inconsistent with the freedom, prosperity, high living standards, and traditions of the American people.”

The Obamacare Evaluation Project: Access to Care and the Physician Shortage
https://www.heartland.org/publications-resources/publications/the-obamacare-evaluation-project-access-to-care-and-the-physician-shortage
Yevgeniy Feyman and Paul Howard of the Manhattan Institute analyze changes in access to primary care physicians under the ACA. They found population growth, demographic changes, and an expansion of insurance spurred by Obamacare will contribute to a significant shortage in primary care physicians over the next decade.

Emergency Department Visitors and Visits: Who Used the Emergency Room in 2007?
https://www.heartland.org/publications-resources/publications/emergency-department-visitors-and-visits-who-used-the--emergency-room-in-2007
Amy B. Bernstein, Mary Ann Bush, and Tamyra Carroll Garcia, of the National Center for Health Statistics examine data regarding the insurance status of patients visiting the nation’s emergency rooms. They found a far higher proportion of patients using the emergency department were covered by Medicaid than those who were uninsured or covered by private insurance. 
 

Nothing in this Research & Commentary is intended to influence the passage of legislation, and it does not necessarily represent the views of The Heartland Institute. For further information on this subject, visit Health Care News, The Heartland Institute’s website, and PolicyBot, Heartland’s free online research database.

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Author
Matthew Glans joined the staff of The Heartland Institute in November 2007 as legislative specialist for insurance and finance. In 2012, Glans was named senior policy analyst.
mglans@heartland.org @HeartlandGR