Study: Affordable Care Act provision had little effect on ER use

Photo credit: Getty/Nils Versemann

Despite what some policymakers predicted, Medicaid expansion did not significantly affect patients’ use of emergency departments, according to a new study, but it did alter the mix of insurance coverage among ED patients.

The study, published in the August issue of Health Affairs, examined the effect of expanded Medicaid eligibility on ED use in 478 hospitals in 36 states in 2014. Here’s what it found:

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  • The number of Medicaid-paid ED visits in Medicaid expansion states increased by 27.1 percent compared to non-expansion states.
  • The share of uninsured ED visits decreased by 31.4 percent in expansion states compared to non-expansion states.
  • Privately insured ED visits dipped by 6.7 percent in expansion states compared to non-expansion states.

Total ED visits, meanwhile, grew 2.9 percent in 2014 compared to 2013--similar to historical rates of ED visits, which have grown at an average annual rate of 2.3 percent between 1997 and 2007. This suggests that ED use for those newly insured with Medicaid was not substantially different than for previously uninsured individuals, the researchers write.

To explain this finding, which differs from previous research, the study points to several factors. For one, the ACA’s temporary “Medicaid payment parity” provision might have made it easier for new Medicaid beneficiaries to access primary care, in turn decreasing demand for ED services.

Indeed, a study published recently in JAMA Internal Medicine found that Kentucky’s Medicaid program and Arkansas’ private option for Medicaid expansion increased outpatient utilization, boosted preventive care, improved healthcare quality, reduced ED use and improved self-reported health.

Further, those newly eligible for Medicaid under the ACA in states that expanded eligibility differ from the populations traditionally served by Medicaid, which could affect how they choose to access the ED, the Health Affairs study notes.

Regardless of the reasons for the study’s results, however, the researchers add that it is “favorable news for the cost associated with the ACA as well as other efforts to expand health insurance coverage in the United States.”

- here’s the Health Affairs study
- check out the JAMA Internal Medicine study

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