Medicaid Expansion Means More ER Visits
A number of years ago, Governor Romney told me that under Massachusetts health reform people would go to physicians’ offices for care instead of going to the emergency room. He wasn’t saying that Massachusetts would deliver more care. He was saying that the care would be more appropriate and less expensive.
As it turns out he was wrong. Traffic to the ER in Massachusetts today is higher than it was before the state’s health reform was enacted.
The same argument has been used by President Obama and by supporters of the Affordable Care Act. And now it turns out they are wrong too. As The New York Times reports:
The study, published in the journal Science, compared thousands of low-income people in the Portland area who were randomly selected in a 2008 lottery to get Medicaid coverage with people who entered the lottery but remained uninsured. Those who gained coverage made 40 percent more visits to the emergency room than their uninsured counterparts during their first 18 months with insurance.
This is consistent with our own predictions in an NCPA study done soon after the ACA was passed. Ah, if only they had listened.
It’s third-party payments!
Right, there has been growing economic literature supporting the idea that third-party payment is responsible for emergency room use, at similar levels to lack of insurance.
What always amazes me is how obvious all these interactions should have been, but seem not to have occurred to what I would have thought were very smart people.
What are these people going to the ER for? A bad cold or something serious?
We would like that it was for things that were serious, but people overuse the ER because going to the ER vs. a physician does not produce much additional cost for insured people even though it is wildly inefficient. We need incentives that push people to get the appropriate provision.
They will never listen.
It makes sense. If you can’t see a doctor for awhile and you’re sick, you’ll go to the ER. I’m confused as to why Romney would have thought otherwise.
That Oregon Health Insurance Experiment had a lot of great information that would have been significant for drafting effective health care legislation…
Medicaid was tacked onto Medicare in the 1960’s and was never meant to be this big of a program. We need to fix it, not expand it.
Like most government programs, it has evolved well beyond its intention.
People go ER’s because:
a. it is cheaper if you are poor
b. the hours are far better — you can go at nite and do not need to take off work
c. All tests are done at the same time, so you do not need further appointments
d. The doctors do not criticize you for your habits if your illness is related to substance abuse
I think the solution is to open up more urgent care centers, even give them federal funding.
There is nothing all that wrong with ER’s. A lot of what we think are funding problems are just hospital accounting problems. The marginal cost of another ER patient is not that high.