Oregon Research Confirms Medicaid Increases ED Use

In 2013, many were surprised to learn that Oregon’s Medicaid expansion did not improve health outcomes. Subsequent research on the same data, published this year, found that low-income, uninsured adults newly covered by Medicaid go to the ER more, not less. As seen in the chart below (reproduced from the article), new Medicaid dependents increased their ED  visits by approximately 40% relative to those who did not enroll. This corroborates what hospitals are starting to admit.


Source: Straining Emergency Rooms by Expanding Health Insurance from Policy Forum.

Even if Medicaid did increase patients’ access to primary care, it would not necessarily reduce ED use. A 2013 RAND survey of ED use shows a large and increasing percentage of U.S. hospitalizations in which the patient was admitted through the emergency department.


Source: The Growing Role of Emergency Departments in Hospital Admissions from the NEJM.

The RAND study cites many cases of patients going to the ED upon the instruction of their physician or another health care professional. The survey found that primary-care practices prefer a schedule of regular, predictable treatment and often refer patients to EDs for cases deemed time-consuming or urgent.

Comments (8)

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  1. Walt Johnson says:

    Should they just rename it from “Emergency Department” to “Auxiliary Department?”

  2. Bob Hertz says:

    John, again you implicitly rely on the unproven assumption that greater ER use means worse public health.

    I for one believe that greater ER use means more persons who would have to pay to see a private doctor, and do not have any money, so they use what appears to be free.

    Not an ideal scenario of course. But does it mean worse public health? Not proven!!

    • Hannah Willis says:

      Bob, your points are very valid. However, to call it “not an ideal scenario” is an understatement. Such market failure prevents sustainable, improved and efficient improvements in public health.

    • John R. Graham says:

      Thank you. Where do I imply that? I never have. My criticisms of hospitals’ EDs are only on their costs, and how hospitals manipulate them.

  3. Bob Hertz says:

    What kinds of people are on Medicaid (in general)?
    -people with no cars
    – people with no paid sick leave
    – people with substance abuse issues
    -people with more exposure to violence

    These factors in themselves would explain a higher use of ER’s. You can go to the ER at any time night or day, and get all the tests you need (at least for the moment).

    I think that if every ER had an affiliated urgent care clinic on site or next door, then patients with mild conditions could be referred out right away. They would not even need to count as admissions.

    • John R. Graham says:

      No cars? Some have proposed subsidizing cars for poor people, in order to increase their mobility and incomes (http://tinyurl.com/mxdw8xf). You may have just added some weight to that argument.

    • Katherine Hoquang says:

      Very thoughtful comment!
      Many social workers advise people who are in needs “Go to the ER!” because it is only option for them in many times.
      Medicaid expansion might need more time to settle various issues.