Medicaid expansion states saw ER visits go up, uninsured ER visits go down

June 19, 2017
States that expanded Medicaid saw ER visits go up while uninsured ER visits went down. Credit: American College of Emergency Physicians

States that expanded Medicaid coverage under the Affordable Care Act (the ACA) saw 2.5 emergency department visits more per 1,000 people after 2014, while the share of emergency department visits by the uninsured decreased by 5.3 percent. The results of a study of 25 states will be published online Monday in Annals of Emergency Medicine, along with an accompanying editorial.

"Medicaid expansion had a larger impact on the health care system in places where more people were expected to gain coverage," said lead study author Sayeh Nikpay, PhD, MPH, of Vanderbilt University in Nashville, Tenn. "The change in total visits was twice as large in a state like Kentucky, where most childless adults were ineligible for Medicaid at any income level before 2014, than in states like Hawaii, where childless adults were already eligible for Medicaid above the poverty line."

The study, which analyzed patient visits in 25 states (14 states that expanded Medicaid coverage and 11 that did not), found that the share of visits covered by private insurance remained constant for expansion states and increased by several percentage points for non-expansion states. Gains in insurance coverage in non-expansion were almost entirely in the form of private coverage, not Medicaid.

Among the visit types that could be measured, increases in department visits were largest for injury-related visits. There was also a large change in payer mix for dental visits, likely because dental emergency department visits are most prevalent among low-income, non-elderly adults, who would be covered by Medicaid. Out-of-pocket dental costs were reported as one of the more unaffordable types of care among the target population for Medicaid expansion under the ACA.

Ari Friedman, MD, PhD, of Beth Israel Deaconess Medical Center in Boston, Mass., who wrote the accompanying editorial, said: "More emergency department visits by Medicaid beneficiaries is neither clearly bad nor clearly good. Insurance increases access to care, including emergency department care. We need to move beyond the value judgments that have dominated so much study of emergency department utilization towards a more rational basis for how we structure unscheduled visits in the health system. If we want to meet patients' care needs as patients themselves define them, the emergency department has a key role to play in a flexible system."

Explore further: Insurance expansion under the ACA provides patients with greater hospital choice

More information: "Impact of the ACA Medicaid Expansion on Emergency Department Visits: Evidence from State-Level Emergency Department Databases" and "The Uncertain Economics of Insurance Enabling More ED Visits" Annals of Emergency Medicine (2017). DOI: 10.1016/j.annemergmed.2017.03.023

Related Stories

Insurance expansion under the ACA provides patients with greater hospital choice

December 19, 2016
During the first year of Medicaid expansion under the Affordable Care Act (ACA), researchers have seen a meaningful shift in the location and type of emergency department services used by patients. These changes suggest that ...

Study finds Medicaid expansion did not increase emergency department use

August 9, 2016
George Washington University (GW) researchers published a Health Affairs study finding that the expansion of Medicaid insurance coverage in the Patient Protection and Affordable Care Act (ACA) did not increase hospital emergency ...

The impact of ACA Medicaid expansion on dental visits: mixed results

April 3, 2017
Dental coverage for adults is an optional benefit under Medicaid, one that about half of the states offer. With thirty-one states and the District of Columbia expanding Medicaid eligibility under the Affordable Care Act (ACA), ...

Medicaid expansion under ACA linked with better health care for low-income adults

August 8, 2016
Two years after Medicaid coverage was expanded under the Affordable Care Act (ACA) in their states, low-income adults in Kentucky and Arkansas received more primary and preventive care, made fewer emergency department visits, ...

Medical care, health have improved for low-income adults under ACA

May 17, 2017
The Affordable Care Act's health coverage expansions have produced major improvements in medical care and health for low-income adults, including reduced out-of-pocket spending, better access to primary care and preventive ...

Alternative insurance expansions under ACA linked to better access, use of care

August 8, 2016
Two different approaches to insurance expansion under the Affordable Care Act (ACA) were associated with increased outpatient and preventive care, reduced emergency department use, and improved self-reported health compared ...

Recommended for you

Expert: Be concerned about how apps collect, share health data

October 20, 2017
As of 2016 there were more than 165,000 health and wellness apps available though the Apple App Store alone. According to Rice University medical media expert Kirsten Ostherr, the Food and Drug Administration (FDA) regulates ...

Three million Americans carry loaded handguns daily, study finds

October 19, 2017
An estimated 3 million adult American handgun owners carry a firearm loaded and on their person on a daily basis, and 9 million do so on a monthly basis, new research indicates. The vast majority cited protection as their ...

More teens than ever aren't getting enough sleep

October 19, 2017
If you're a young person who can't seem to get enough sleep, you're not alone: A new study led by San Diego State University Professor of Psychology Jean Twenge finds that adolescents today are sleeping fewer hours per night ...

Across Asia, liver cancer is linked to herbal remedies: study

October 18, 2017
Researchers have uncovered widespread evidence of a link between traditional Chinese herbal remedies and liver cancer across Asia, a study said Wednesday.

Eating better throughout adult years improves physical fitness in old age, suggests study

October 18, 2017
People who have a healthier diet throughout their adult lives are more likely to be stronger and fitter in older age than those who don't, according to a new study led by the University of Southampton.

Global calcium consumption appears low, especially in Asia

October 18, 2017
Daily calcium intake among adults appears to vary quite widely around the world in distinct regional patterns, according to a new systematic review of research data ahead of World Osteoporosis Day on Friday, Oct. 20.

0 comments

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.