Obamacare Medicaid Expansion to Worsen Hospital ER Burden

[Purveyor]

By Alex Wayne and Jeanna Smialek - Jan 3, 2014

Emergency rooms may be a preferred choice for care among 3.9 million people newly enrolled in the U.S. Medicaid program for the poor, according to a study that suggests Obamacare’s costs may be higher than expected.

The concern is being raised by economists who said a state Medicaid expansion in Oregon five years ago led newly insured patients to visit ERs 40 percent more often than the uninsured. That finding, published in the journal Science, runs counter to government assumptions that the newly insured would choose lower-cost options for care, such as doctors’ offices.

More than 19 million people nationwide are projected by the government to join Medicaid this year, a 35 percent jump from last year as the Patient Protection and Affordable Care Act broadens eligibility. The rising participation is projected by the Obama administration to boost spending on the program by 18 percent this year and almost double it to $957 billion by 2021.

“That leaves policymakers with the difficult evaluation of comparing the substantial real costs of the program, with the substantial benefits to enrollees of having the coverage,” Katherine Baicker, an economist at the Harvard School of Public Health who helped write the study, said in a phone interview.

Baicker and her fellow researchers found that people who gained Medicaid coverage used ERs more often for “a broad range of types of visits, conditions and subgroups,” including problems that could be treated in less costly settings.

Non-Emergency

more...

http://www.bloomberg.com/news/2014-01-02/obamacare-s-medicaid-expansion-may-create-oregon-like-er-strain.html

[elleng]

1. Really too bad.

Think this is because of 'familiarity,' ease of entry?

[1StrongBlackMan]

2. Yep ...

And, I suspect this will slow down as the previously uninsured have chronic and long, unattended to health issues attended to and are guided to primary care physicians.

BTW ...

I work at a University with a Medical School attached. An interesting recent statistic ... applications are down slightly; but current students opting for Family Practice and Emergency Medicine residencies are ticking up. And, I'm hearing that there is a plan to cut tuitions/increase ways to pay for Med School. And there seems to be a belief that those entering and doing so with providing care, not buying yachts, as the ends.

It seems some folks are getting the message.

[elleng]

3. Good to hear that some folks are getting the message.

[Shandris]

4. While I understand the reasoning behind this sentiment...

...I'm not entirely sure I agree with it. Another problem for those who the Medicaid expansion covers -- the unemployed/underemployed -- is that so many of them are working in occupations where getting a regimen of proper care is too costly in terms of time spent and work lost. I don't think most people (and in no way am I meaning you, 1StrongBlackMan, but rather a general group of people) understand just how much of a stigma the thought of losing a day's work really is to low-income folks. I suppose it's possible that out on the coasts, this isn't quite as true as it is here in the Midwest, but I would note that the case that sparked this was out of Oregon, so it can't be -too- different (or the reasoning is different).

It doesn't matter how many people are available to give proper care if you can't afford to take the time off to go get it. This is a problem that plagues my area and the people in my life on a continual basis.

[Butterbean]

5. Very much agree with that last paragraph.

That is a problem that I see/hear about from my patients all the time, and it is something that needs to be addressed right along with the problem of people using the ER as their PCP. My PCP is open 7 days a week, AND has urgent care/walk in hours every day all day, which is a rarity. If more docs were like my docs, I'll bet more people would be able to get care. I can't always make an appointment, but I know my docs are open 7 days a week, and I know that urgent care option is available at no extra charge, so I rarely if ever go to the ER unless it's a true emergency.

So many people don't have that luxury, and that's something that needs to be addressed. It's not just that they don't have a PCP, it's that they work all the freaking time and have no time off.

[Wounded Bear]

6. This ^^ is what I first thought when I read the headline...

though the 'familiarity' argument has merit IMHO. Being one of the working poor, I don't get much in the way of PTO-paid time off-for things like medical visits.

Luckily for me, I work night shift, so I can get most things done if I schedule morning visits. But the premise still stands. If you're making minimum wages, you probably don't get much in the way of sick pay or other benefits. And if you're working part time, you get none. If you're working both, then you might have more than one job, making scheduling things like Dr visits a byzantine proposition.

[1StrongBlackMan]

7. Great point(s) ...

that to be honest, I had not really considered because I had not thought about the under-employed.

[Warren Stupidity]

8. part of the ridiculous ER costs are because large numbers of people being treated

historically had no insurance and no ability to pay, so actual costs were adjusted to reflect the default rates. The article apparently forget to mention that all these "new" people are an overlapping set of the same population that used the ER and without being able to pay. Over time the decline in defaults will reduce per capita ER charges. In addition the newly insured will also, over time, start getting regular care from primary physicians etc.

This is just more of the same: the campaign to demand instant perfection and optimal results from the ACA, and to be outraged and horrified at anything else.

[Egalitarian Thug]

9. Committed ACA critic here, but this was both predicted and inevitable. As people come

Last edited Fri Jan 3, 2014, 05:26 PM - Edit history (1)

into the health care system that have never had access before, they are going to have an inordinate number of ailments to address at the start. Many are probably going into ERs because that the only place they know to go to.

The ACA still sucks, but this is actually a good thing.

BTW I don't know if you remember this, but the very first scene in Sicko was an Oregon man that had to decide which of the two fingers he accidentally cut off to save because he could not afford to save them both, or his insurance wouldn't cover it(?).

[Igel]

10. Predicted, actually.

But the prediction was denied. That was based on Massachusett's track record, where the same thing happened. Part was an additional factor--trouble getting GP appointments.

Actually, it's still a prediction for the ACA since on day 2 of coverage it's really hard to see what the effects will be in terms of, well, pretty much anything.

[jwirr]

11. I am covered by Medicare and Medicaid. If I made it a practice to go to the emergency room for

the usual visits these programs would soon tell me that they would not be covering unauthorized visits to the ER. I suspect that is the way this will be handled.

A real emergency yes. Because you do not want to go to a clinic no.