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Research & Commentary: Is the Affordable Care Act Helping Emergency Rooms?

May 27, 2015

One of the central goals of the Affordable Care Act (ACA) was to limit the number of patients using emergency rooms as their primary venue for health care treatment.

stethoscope and insurance docs

One of the central goals of the Affordable Care Act (ACA) was to limit the number of patients using emergency rooms as their primary venue for health care treatment. While many low-income patients routinely use expensive emergency room (ER) services because they cannot afford a doctor, many others wait until they are severely ill before visiting the ER. Since many indigent patients cannot afford health insurance or health care fees, they place a significant burden on health care staff and drive up the cost of care. 

ACA architects argued ensuring everyone had a health insurance plan would encourage patients to take advantage of preventative care and use their own doctors instead of the ER. The reality has been the opposite: The number of emergency room visits by low-income patients has increased since Obamacare went into effect, according to a 2015 survey of members of the American College of Emergency Physicians (ACEP). 

The ACEP study found noticeable increases in the number of people seeking ER care. Three quarters of the 2,099 doctors surveyed said they witnessed increases in the number of patients using ER services. Forty-seven percent of those responding to the ACEP poll saw a slight increase and 28 percent reported a large increase. Fifty-six percent found 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 ACA’s implementation. 

Many health care experts believe high numbers of uninsured patients cause overcrowding of emergency rooms. A 2010 report from the National Center for Health Statistics (NCHS) debunks that assumption, finding nearly 32 percent of Medicaid enrollees used an ER at least once during a 12-month period ending in 2007. Individuals with private health coverage were half as likely to use ER services (17 percent). The uninsured also fared better than the Medicaid population. Only one in five individuals without health insurance used the ER in that period. 

The results have been similar in the Obamacare era. A study by the Colorado Hospital Association found emergency-room visits in states that expanded Medicaid under Obamacare increased by 5.6 percent in 2013–14, more rapidly than the 1.8 percent increase reported by their counterparts. A 2008 Harvard University study found after Oregon expanded its Medicaid program, newly insured Medicaid patients went to the emergency room 40 percent more often than uninsured patients. 

One of the many goals of ACA was to lessen the burden of uninsured patients on the nation’s emergency rooms. The new laws attack the wrong problem and accomplish the opposite by pushing states to expand their failed Medicaid systems to cover more people. Repealing ACA and Medicaid expansion would decrease the pressure on the nation’s emergency rooms. 

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

Ten Principles of Health Care Policy
http://heartland.org/policy-documents/ten-principles-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
http://heartland.org/policy-documents/no-128-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
http://heartland.org/policy-documents/obamacare-evaluation-project-access-care-and-physician-shortage
Paul Howard and Yevgeniy Feyman 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 Docs Expect Patient Influx, Lower Quality Care
http://dailycaller.com/2014/05/21/emergency-docs-expect-patient-influx-lower-quality-care/#ixzz33hSCEIEA
Sarah Hurtubise of The Daily Caller reports emergency room visits have risen since Obamacare went into effect and more ER physicians expect the law to hurt more than it helps. 

Emergency Department Visitors and Visits: Who Used the Emergency Room in 2007?
https://www.heartland.org/policy-documents/emergency-department-visitors-and-visits-who-used-emergency-room-2007   
Tamyra Carroll Garcia, Amy B. Bernstein, and Mary Ann Bush 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 ER were covered by Medicaid than those who were uninsured or covered by private insurance.   

Impact of Medicaid Expansion on Hospitals: Updated for Second-Quarter 2014
https://www.heartland.org/policy-documents/impact-medicaid-expansion-hospitals-updated-second-quarter-2014 
The Colorado Hospital Association found emergency room visits increased three times as rapidly in states that expanded Medicaid under Obamacare than in those that did not do so. 

Doctors Say ER Visits Continue to Climb, Despite Obamacare Promises
http://blog.heartland.org/2015/05/doctors-say-er-visits-continue-to-climb-despite-obamacare-promises/
Writing in Somewhat Reasonable, Gene Koprowski discusses a new poll of physicians that indicates emergency room visits by indigent patients are rising in the United States five years after the Obamacare legislation was passed partially on the promise to reduce those numbers.  

Report: Uninsured Emergency Room Use Greatly Exaggerated
http://news.heartland.org/newspaper-article/report-uninsured-emergency-room-use-greatly-exaggerated
This Heartlander article examines a report from the National Center for Health Statistics, the nation’s chief health statistics agency, suggesting the longstanding perception of uninsured patients clogging the nation’s emergency rooms is a myth. 

Obamacare’s Impact on Doctors—An Update
http://www.heritage.org/research/reports/2013/08/obamacares-impact-on-doctors-an-update
In this 2013 Heritage Foundation Issue Brief, Alyene Senger outlines several effects of Obamacare on doctors: “Specifically, physicians will be subject to more government regulation and oversight, and will be increasingly dependent on unreliable government reimbursement for medical services. Doctors, already under tremendous pressure, will only see their jobs become more difficult.”

Nothing in this Research & Commentary is intended to influence the passage of legislation and does not necessarily represent the views of The Heartland Institute. For further information on this subject, visit Health Care News at http://news.heartland.org/health, The Heartland Institute’s website at http://heartland.org, and PolicyBot, Heartland’s free online research database, at www.policybot.org.   

The Heartland Institute can send an expert to your state to testify or brief your caucus, host an event in your state, or send you further information on a topic. Please don’t hesitate to contact us if we can be of assistance! If you have any questions or comments, contact John Nothdurft, Heartland’s director of government relations, at jnothdurft@heartland.org or 312/377-4000.

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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