Visits to Emergency Departments Increased Three Times Faster in States that Expanded Medicaid than Those that Did Not

The Colorado Hospital Association has issued a report comparing certain trends in states that expanded Medicaid under Obamacare with states that did not. The most important take-away is how much Emergency Department visits increased in expansion states versus non-expansion states:

The average number of emergency department (ED) visits to hospitals in expansion states increased 5.6 percent from second-quarter 2013 to second-quarter 2014. This change was greater than expected from the variation over the last two years, and resulted in the highest number of average visits over that time. In comparison, hospitals in non-expansion states reported a 1.8 percent increase in Emergency Department visits between the second quarters of 2013 and 2014.

The report also looked specifically at three neighboring states to Colorado: Washington and Oregon (which expanded Medicaid), and Montana (which did not):

Overall, Emergency Department visits have increased from second-quarter 2013 to second-quarter 2014 in Washington and Oregon, while remaining steady in Montana. Washington reported an 8.5 percent increase in the average number of Emergency Department visits per hospital, and Oregon, 6.5 percent, while Montana reported only 0.8 percent growth over the same time period.

This report is part of an advocacy effort in favor of expanding Medicaid, a priority of hospitals since Obamacare was passed. Despite dramatically increasing Emergency Department visits, Medicaid expansion does reduce the proportion of “self-pay”, a.k.a “charity” cases presenting at hospitals.

These terms, of course, are offensive because a “self-pay” patient may be capable of paying his bills; and a Medicaid patient is also a charity case. In expansion states, Medicaid charges increased 3.5 percentage points more in expansion states than in non-expansion states, whereas self-pay patients’ charges dropped 1.2 percent more and privately insured charges dropped 2 percent more.

Does that make sense? To support a policy that seems to move more privately insured patients onto Medicaid than self-pay patients? It makes no sense on the face of it, because private payers pay higher fees than Medicaid does.

The only way it appears to make sense is if the increase in Emergency Department visits is an unstated goal of the hospitals.

I’ve previously discussed research predicting that Obamacare will increase ED profits, and previous evidence from Arizona suggested it, too. Medicaid patients use expensive Emergency Departments because Medicaid’s low physicians’ fees discourage doctors from seeing them.

It looks like health care under Obamacare will become less accountable and less coordinated — exactly the opposite of what was promised.

Comments (9)

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  1. Perry says:

    No surprises here.

  2. Devon Herrick says:

    I don’t know why this was not expected. Government reports have found ER use is closely associated with Medicaid patients. They seek care in the ER more frequently than both the uninsured and those covered by private insurance.

    o Nearly one-third (32 percent) of Medicaid enrollees used the ER at least once during a 12-month period in 2007.
    o Individuals with private health coverage were only about half as likely (17 percent) to visit an ER, and a similar proportion — one in five — of individuals without health coverage did so.
    o Medicaid enrollees were three times as likely (15 percent vs. 5 percent) as the privately insured, and twice as likely as the uninsured (15 percent vs. 7 percent), to have visited an ER twice in the previous year.

  3. Big Truck Joe says:

    I know it’s politically incorrect to even mention, but has anybody done a study of Medicaid patients to show that as a segment of the population – those on welfare and thus Medicaid – are simply less self sufficient and more likely to not take care of themselves thereby not seek preventive care or lower cost physician care and wait till their personal health detiorates enough to necessitate an ER visit? And with the press coverage of Obamacare, the Medicaid population sees their coverage as free (or paid by the federal govt) so they are apt to utilize it more. Just a thought.

    • John R. Graham says:

      Few are as blunt as you. Nevertheless, many health-policy experts describe the Medicaid population as hard to get to and hard to serve.

      There is also research indicating that the higher-income Medicaid eligibles are more likely to sign up and use Medicaid than the lower-income eligibles, suggesting that they are somewhat better able to navigate the system.

  4. bob hertz says:

    There is a fascinating article about this in a magazine called Oklahoma Watchdog, June 2013, on the subject “ER Use by Medicaid patients costs Oklahoma taxpayers $170 million.”

    The average reimbursement by Medicaid for ER use was $321 per episode.

    There are many American in the world of private insurance who are sitting with $2,000 or $5,000 bills for one ER visit.

    (by the way, this is a main reason why I have always argued against the arguments of Avik Roy about how bad Medicad is for the poor. My god, a $321 bill paid by someone else vs a much larger deductible and coinsurance that you have to pay? Mr Roy is smart, but he misses badly on this item.)

    Another statistic:

    Medicaid had about 50 million non-disabled enrollees in 2010. Oklahoma had about one million.

    On that rough basis, ER use in Medicaid cost the taxpayers about $8.5 billion.

    That is actually not so scandalous, in my view. Any type of indigent health program in a nation as large as the US is going to spend that much on emergencies.

    • John R. Graham says:

      However, the whole point of Medicaid is to give people timely access to care so they don’t have to go to the ER. That is failing.

  5. Big Truck Joe says:

    I know, I know – I’m Big Truck Joe and I’m disgusting. But I’m just awed by the fact that Uwe Reinhardt might be reading my cruel and uncaring economic postulations. I used to read his books in graduate school and now, to think, HE might be reading ME!

  6. Bob Hertz says:

    John, if Medicaid is only spending $321 per ER visit, I am not sure it really matters whether a patient gets treated in a clinic or in the ER.

    • John R. Graham says:

      I regret that I have not seen the source cited by Mr. Hertz. I regret I also don’t know the conditions for which Medicaid patients present to the ER. The CDC reports the data, but I do not believe broken down by payer. (I may be wrong.)