Emergency department visits by uninsured patients drop in Illinois after Medicaid expansion

New research adds to a growing body of evidence suggesting that the expansion of Medicaid under the Affordable Care Act (ACA) helped low-income families rely less on emergency department visits for medical care.

The study abstract, "Effect of Affordable Care Act Medicaid Expansion on Emergency Department Visits by Uninsured Patients in Illinois 2009-2015," will be presented on Friday, Nov. 2, at the American Academy of Pediatrics (AAP) 2018 National Conference & Exhibition in Orlando, Fla.

In Illinois, according to the abstract, Medicaid expansion was associated with a significant drop in uncompensated care in department by patients without insurance between 2009 and 2015. The ACA extended Medicaid coverage eligibility to adults with incomes up to 133 percent of the federal poverty level.

"As a result of the ACA, 850,000 people in Illinois gained health insurance during the study period," said abstract author Peter Nguyen, MD, a Pediatric Emergency Medicine Fellow at Michigan State University's Helen Devos Children's Hospital who previously studied in Illinois. "During the same time, we saw a significant drop in emergency department visits by patients without insurance."

Researchers analyzed emergency department visits using data from the Healthcare Cost and Utilization Project and found there were a total of 31.2 million emergency department visit in Illinois during the study period. Of these, 4.1 million were visits by uninsured patients.

Uninsured emergency department visits in the state peaked right before ACA implementation, Dr. Nguyen said, when they accounted for 16 percent the visits. Post-ACA implementation, there was a 40 percent reduction in uninsured emergency department visits.

"This study adds to the growing body of evidence that the ACA can be beneficial in promoting patient-centered care, shifting it from the emergency department to a patient's medical home for ongoing, comprehensive care. This is a healthier situation for everyone," Dr. Nguyen said.

Dr. Nguyen said that proposed policy changes may slow the reduction in uncompensated emergency department visits. "With increasing uncertainty about the long-term plan for the ACA, enrollment has started to decline," he said. "So, it will be interesting to see whether we'll see a rise again in uninsured emergency department visits."


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