ER use increased after Oregon expanded Medicaid

Medicaid expansion didn't stop Oregon patients from seeking care at the emergency room, according to a new study. Visits remained high two years after previously uninsured patients received health insurance. 

The Beaver State implemented a limited, lottery-based Medicaid expansion in 2008, two years before the passage of the ACA.  In 2012, researchers noted that the expansion improved patients’ financial security and the likelihood they would visit their primary care providers when sick. However, more recent research by the same team also found ER use continued to go up, according to a study published in the New England Journal of Medicine

The findings are similar to other pre-ACA coverage expansions such as Massachusetts’ 2006 healthcare reform law.

Advocates of the expansion hoped ER use would decline with time as beneficiaries became acclimated to coverage. However, the study found that Medicaid patients were more likely to seek care at both the ER and their primary care provider.

One possible reason is that newly-insured patients want to increase their healthcare use across the continuum of care, according to Bill Wright, Ph.D., director of the Providence Center for Outcomes Research and Education, and his team.

Leslie Clement of the Oregon Health Authority noted that despite these numbers, avoidable ER use is down 4 percent in the state, indicating potential for cost savings in such areas as increased preventive care use and improved care coordination.

"It is not just a 'open up coverage and let people used healthcare services as they have done historically,'" Clement told Oregon Public Broadcasting. "It's reforming that system."