Medicaid expansion under Obamacare had little effect on ER visits

Maryland expanded its Medicaid eligibility program in 2014 as part of the Affordable Care Act but saw little difference on the number of visits to emergency rooms.

By Amy Wallace

July 24 (UPI) -- A new study at Johns Hopkins found that the expansion of Medicaid under the Affordable Care Act had little effect on the number of emergency room visits.

Researchers at Johns Hopkins School of Medicine analyzed the ACA Medicaid expansion in 2014 in Maryland to see if the program made a difference in the amount of patients visiting the emergency room.


"Through the Medicaid expansion, there were some people who believed more patients would choose to go to primary care providers instead of the emergency department, because now they have health coverage, and there were some people who believed that the expansion would swamp the emergency department," Eili Klein, an assistant professor of Emergency Medicine in the Johns Hopkins University School of Medicine, said in a press release. "We wanted to look at what actually happened."

Researchers examined patient visits at emergency departments across the state of Maryland for an 18-month time period before and an 18-month time period after the ACA Medicaid expansion took effect in 2014. The first six months of 2014 were excluded from the study.

The study, published July 24 in the Annals of Emergency Medicine, found the number of people covered by Medicaid in the state increased more than 20 percent as 160,000 Maryland residents enrolling in Medicaid. The total number of emergency room visits fell by more than 36,000 during the same time period.


"Thirty-six thousand may seem like a lot of visits, but, in Maryland, that only equates to about a 1 percent change," Klein said. "So, the effect of expanding Medicaid seems to have had no effect on emergency department utilization at an aggregate level."

The study found that Medicaid covered 6 percent more visits during that time period, but the number of uninsured patient visits also decreased by 6 percent.

"When the patients came in to the emergency department, the payer mix changed," Klein said. "So people were much more likely to be insured now than they were previously. And most of that was people who were uninsured who then became insured by Medicaid."

Researchers stressed that even though the ACA did not reduce the burden on emergency departments, the program does have benefits in that it protects patients from expenses of health care services and provides increased financial security to hospitals.

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