New research suggests Medicaid expansion has not significantly reduced emergency department visits in Maryland, though it has changed the mix of payers.
The Johns Hopkins study, published in the Annals of Emergency Medicine, tested the hypothesis that Medicaid expansion under the Affordable Care Act would encourage more patients who used the emergency room for care to seek out primary care providers instead. While the analysis did show a drop of 36,000 in the number of visits to emergency departments, that figure represents a change of around 1%, said Eili Klein, Ph.D., an assistant professor of emergency medicine at the Johns Hopkins University School of Medicine and one of the study’s authors, in a study announcement.
Within those numbers, the team found that the decrease in uninsured visits to the emergency room roughly equaled the increase in visits by patients with Medicaid coverage. That finding is in line with previous research suggesting Medicaid expansion has so far had more of an effect on the number of insured individuals than it has where newly insured patients interact with the healthcare system, with some studies even showing an increase in emergency room visits.
These findings should not come as a surprise, according to Gabor Kelen, M.D., director of the Johns Hopkins department of emergency medicine. “The ACA did not really address incremental primary care access for the newly insured,” he says. Kelen also notes that for people newly covered by Medicaid, the only previous option for care would have been emergency rooms, so it would be unrealistic to expect them to change, especially when many members of that population suffer from legitimately emergent conditions.
Klein noted that the fact the ACA has not reduced the workload in emergency departments does not mean it has failed to offer other benefits. He pointed to increased financial security as a benefit for both hospitals and patients when fewer uninsured individuals visit emergency departments.