Medicaid expansion linked to shifts in ER access

Emergency room sign
A new study examines how certain patients' ER access changed after Medicaid expansion. (Getty/Nils Versemann)

Medicaid expansion appears to have provided some patients with greater choice of hospital facilities when they need emergency care, according to a new study.

The study, published in the Annals of Internal Medicine, looked at the number of emergency department visits, type of visit and average travel time to the ED among uninsured and Medicaid-insured nonelderly adults at 126 for-profit hospitals. Researchers compared changes between the end of 2013 and the end of 2014 for patients from 17 Medicaid expansion states versus 19 nonexpansion states.

They found that by the end of 2014, the EDs in expansion states saw a 47.1% decrease in uninsured visits and a 125.7% increase in Medicaid visits. In addition, the average travel time to an ED for Medicaid patients with conditions requiring immediate medical attention decreased by 6.2%.

The study authors say they found little evidence of similar changes among patients from nonexpansion states in the same time period. They do note, though, that since the study only included for-profit hospitals, it “limits generalizability to other hospital types.”

Yet previous research indicates that poor and uninsured patients will often travel out of their way to seek treatment at nonprofit facilities that might offer free or discounted care, senior study author John Graves of the Vanderbilt University School of Medicine told Reuters.

Thus, the finding that nondiscretionary ED visits increased at for-profit hospitals, plus evidence that Medicaid patients in expansion states traveled shorter distances to an ED, shows that “people shifted where they sought ED care when they needed it,” he said.

A previous study found that Medicaid expansion did not significantly affect patients’ overall use of EDs, but it did decrease the share of uninsured ED visits and increase the number of Medicaid-paid visits.

Research has also linked Medicaid expansion to reduced uncompensated care for hospitals. Thus, some hospital leaders are worried about what will happen if Republicans roll back Medicaid expansion when they assume control of the White House and Congress.

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