Medicaid expansion hasn't boosted ER visits to U.S. hospitals, study finds

By Brian P. Dunleavy

Dec. 11 (UPI) -- Expansion of Medicaid eligibility as mandated by the Affordable Care Act has not increased emergency room visits among beneficiaries, as many opponents of the law feared, an analysis released Wednesday revealed.

And, notably, visits to primary care physicians among Medicaid beneficiaries increased in the first three years after the ACA went into effect -- a possible sign that the legislation has been effective at making these healthcare services more accessible for low-income families. These are among the key findings of a study published in the Journal of General Internal Medicine.


"At the time of the law's passage, there were concerns that expanding the number of Medicaid beneficiaries would increased the burden on emergency [rooms], because that's historically where a lot of Medicaid recipients went for even basic care services," study co-author Yusuke Tsugawa, assistant professor of medicine at UCLA, told UPI, adding that state governments were particularly worried, given that they would need to find room in their budgets to cover the related costs.


"But our analysis shows that's not what's happened, at least on a national level," he noted.

Tsugawa and his colleagues reviewed data from a random sample of nearly 18,000 Medicaid recipients included in the 2010-16 Medical Expenditure Panel Survey, a project coordinated by the U.S. Agency for Healthcare Research and Quality. Their goal was to see if the findings of the Oregon Health Insurance Experiment, which documented increases in hospital outpatient visits and ER use among new Medicaid recipients in the state over a three-year period, would be consistent with national trends following passage of the ACA.

"The Oregon findings were an Indication that providing health coverage alone might not be sufficient to navigate people to pursue appropriate care," Tsugawa said.

Based on the findings of the team, however, the Medicaid expansion provision of the ACA seems to be "achieving its targets," he noted. From the law's implementation at the beginning of 2014 through the end of 2016, they found no indication that ER use among Medicaid recipients had "changed meaningfully."

Meanwhile, visits to primary care physicians among the beneficiaries studied increased by nearly 4 percent during the first three years following Medicaid expansion.

"This suggests new Medicaid recipients are accessing care appropriately, and perhaps getting care for their health problems earlier, as opposed to waiting until symptoms worsen before going to the hospital," Tsugawa said. "And, in most cases, a visit to a primary care doctor will be less expensive, for both the patient and the government, than if they went to the hospital."


Expanding the eligibility for Medicaid was a key provision of the ACA, also known as Obamacare, when it was passed in 2010. The law expanded the population of those eligible for the government healthcare coverage program to include individuals earning up to 138 percent of the federal poverty level.

Prior to the ACA's passage, many uninsured Americans, as well as those on Medicaid, relied on hospital ERs for routine care services, and some officials worried that making more people eligible for coverage would over-burden facilities, and state budgets, across the country. States cover the costs of healthcare services for residents who are Medicaid beneficiaries.

"At least in terms of location of care, I think ACA is achieving what it's supposed to be achieving," Tsugawa said.

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