Study: Expanding Health Coverage Increases Emergency Room Use

If the finding holds true, it could undercut an argument for the new health care reform law

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Expanding health insurance coverage for the poor leads to a significant increase in costly emergency room visits, according to a new study. The finding, published Thursday in the journal Science, raises the possibility of trouble ahead as millions of people gain health insurance through expansion of Medicaid under the new health care reform law, coverage that began kicking in on Wednesday.

The 18-month study followed 25,000 low-income Oregonians who won Medicaid coverage in a lottery as part of the Oregon Health Insurance Experiment, a major policy research initiative. Researchers observed a 40 percent increase in emergency room visits among the newly insured.

According to the study’s authors, the correlation between increased emergency room and expanded health coverage was so strong it held true “across a broad range of types of visits, conditions, and subgroups, including increases in visits for conditions that may be most readily treatable in primary care settings.”

If it holds true, the study’s central finding threatens to undermine an argument made by proponents of the Affordable Care Act  — including President Barack Obama — that the number of costly emergency room visits would decrease if more people had insurance that covered the cost of seeing a primary care doctor.

“I think that it’s very important that we provide coverage for all people because if everybody’s got coverage, then they’re not going to the emergency room for treatment,” Obama said in 2009, according to the New York Times.

An Obama administration spokesperson said the study’s time frame was too short to see behavioral changes in people accustomed to seeking medical care through the emergency room, and pointed to a longer-term study in Massachusetts, which showed expanded coverage led to an eight-percent decline in emergency room use over several years.

Dr. Amitabh Chandra, director of health policy research at the Harvard Kennedy School of Government, called the study’s results “breathtaking” and said that in previous studies the results were too ambiguous to reach a clear conclusion.

“You would conclude what you wanted to conclude depending on which side of political aisle you were on,” he told the Times. “Now we have an answer.”

Under the Affordable Care Act, nearly 25 million Americans could gain health insurance, roughly half of them through Medicaid.

[Science]

54 comments
quarkaz1
quarkaz1

Typical right wing bull dung propaganda distortion, and knee jerk reaction. These people showing up at emergency rooms, have been locked out sensible health care for so long, that they now have acute symptoms, that were previously treatable in an outpatient situation. Millions of decent hard working intelligent people have been devastated by (trickle down lunacy), and the great Bush neo-con recession of 2008 resulting from that utterly discredited economic scam. Millions have lost good jobs, and healthcare as a result. They have often developed conditions that become more complex due to lack of treatment, and early detection. The same people at (Time) attempting to paint these people as sophisticated loafers milking the system, infer at the same time, that these people are to stupid to get a primary care doctor. "What a crock." Only a dam fool would go to the emergency room for treatment if there was a realistic option. To write this article without fully taking that into account, is just irresponsible garbage propaganda. As time goes by, and these people realize that they are no longer considered "expendable" second class citizens they will quickly move to a sensible regime of check ups, early treatment, detection,, lower system costs, and significant easing of emergency room visits. Only a disingenuous idiot would not understand that. Furthermore only a fool would not recognize that providing healthcare to all citizens at some basic level is essential to a healthy medical system, and a healthy economy. Try driving your car and never changing the oil. Melt down won't be far away. The real answer is medicare for everyone. That will eventually happen. It is inevitable, and will become wildly popular, once economists that aren't on the Koch brothers payroll, find out how it raises productivity, and literally saves our nation hundreds of billions of dollars by not shoving our problems under a rug, as right wingers love to do. If the radical Tea bagger lunatics hadn't been trying to sabotage this program since day one ,we could have averted this problem by establishing special screening centers, even if only on a temporary basis, until the back log of patients subsided. A year from now the nay sayers, and radical lunies on the far right will be forced to grudgingly admit that the (Affordable Care Act) was the best new idea since medicare, and will be dumfounded by it's success. Grow up!

harmonyjayjay
harmonyjayjay

With new healthcare laws it can be a little tricky knowing what kinds of doctors you can see so it isn't too surprising that this is happening, especially among a younger demographic. What is clear though is people need places they can go.  One of the best urgent care facilities I know if is actually all over New York and does an amazing job. Check them out. http://premiercare365.com/urgent-care-locations.php

questionauthority
questionauthority

so lets fix the problem

If you can take the time to comment on this article about the short comings of the ACA you can take the time to call your representative and suggest that they should amend the bill to solve these problems.

StephenMeier
StephenMeier

the readers don't like the science and there for they reject the conclusion.  You might have thought this was a discussion of evolution instead of health care. So when science comes into play liberals are as likely to reject the evidence as conservatives?

Think about it....

JerseyBubba
JerseyBubba

This is really old news and bad logic. Years ago before the AHA was even a thought NYC had a similar problem with Bellevue Hospital. Everyone would show up at the ER for anything-- sore throat, upset stomach, etc. Former Mayor David Dinkins forced people to get a medical ID card that assigned them a specific doctor and neighborhood medical clinic. He had opened 63 neighborhood clinics. So, you can't look at this issue in the short term. It requires a change in attitude and habits by people who never had a regular family doctor.

BruceS78
BruceS78

Seems like this is another stupid study that doesn't mean anything.  The real question should have been where were these patients getting their healthcare before they were enrolled in Medicaid.  Probably the ER.  So nothing really changed.  If I were running a hospital, I would set up a 24 hour urgent care next to my ER and send all of these people with non-ER issues to the urgent care.  I have never understood why hospitals can't change their operations to keep people out of the ER.  Also, Oregon state officials need to start educating their Medicaid patients on where to get health care.

NoNonsense
NoNonsense

Gee,,and no mention of the MIT study that concluded the same thing.


I love this one  Dr. Amitabh Chandra, director of health policy research at the Harvard Kennedy School of Government, called the study’s results “breathtaking” and said that in previous studies the results were too ambiguous to reach a clear conclusion."

A policy director at Harvard calling the results breathtaking, saying PREVIOUS studies were too ambiguous ...and the O-bots pan it as right-wing talking points.

It would be funny if it weren't so disgusting.

cent-fan
cent-fan

I believe limited procedure clinics are popping up all over the place.  They're probably the newest hot franchise industry.  They cover people that get sick on the weekend or don't want to wait for their Primary to get back from the Bahamas.  Now certainly there are some drawbacks to going to a doctor that doesn't know you (yet) and who is just working the shift, but it's no different than an emergency room except that it will probably be faster treatment if what you have isn't really an emergency.


This has nothing to do with the healthcare law.  It's the state of health services as they exist now.  If they want to compete or make money the healthcare industry is going to have to adapt and fill the demand on the public's terms... like being available for all contingencies, great and not great, like a 24/7 Wal-Mart.  

ApostasyUSA
ApostasyUSA

I'd figure we could expect a little better from Time magazine in reporting these right wing talking points, but alas, the media is only as truthful and forthcoming as they are paid to be.  Hacks are everywhere.

Anyways, the study showed allot more than "more ER visits."  Many studies related to expanding health coverage for people show:

 1. Emergency room visits do tend to increase after an initial coverage expansion, but that increase isn't permanent.
2. 
 Experts in the health industry aren't surprised by these findings.

"
The same thing is happening in Oregon, which received a Medicaid waiver in 2012 to begin “treating thousands of patients through provider networks called coordinated-care organizations.” The state began focusing on using prevention and coordination of health care issues to reduce overall costs, encouraging people who turn up in the emergency room to “get their health care from regular doctors instead.” Early data shows that the experiment has been a success: Emergency room visits by people served by CCOs decreased by 9 percent from 2011 and emergency room spending is down 18 percent from 2011. What’s more, CCOs “reduced hospital admissions for congestive heart failure by 29 percent, chronic obstructive pulmonary disease by 28 percent and adult asthma by 14 percent.”

But since the Oregon study only looks at emergency department use for newly-eligible Medicaid beneficiaries over the first 18 months, it may not have had a chance to document these long-term shifts in policy reform and patient behavior."

I am so tired of Republicans media hacks.  They are so gullible!!!

sixtymile
sixtymile

I'm a little surprised that none have commented that the group studied "won" healthcare in a lottery and this makes the psycho-social context of this study unique. Isn't it interesting that these results depart from other "ambiguous" studies... if the results of this study are statistically more significant than others that doesn't make the result "better". Hey there Dr. Chandra: it could just be wrong.

grape_crush
grape_crush

>  raises the possibility of trouble ahead as millions of people gain health insurance through expansion of Medicaid under the new health care reform law

There's a lot missing here...The problem isn't as much that emergency room visits occur, it's that hospitals weren't getting paid for said visits. Even if there is a sustained increase in demand for services, wouldn't that prompt the healthcare industry to fill that need?

> "...that the number of costly emergency room visits would decrease if more people had insurance that covered the cost of seeing a primary care doctor."

That's an education and availability-of-care issue. I don't go to the ER for a head cold, but I do for an emergency appendectomy or a broken leg. Questions I have are about what other options these people have besides going to the ER and whether or not they know about them.

SmoothEdward1
SmoothEdward1

The is just an absurd conclusion. People need to be trained and taught to change lifelong habits of seeking care in these settings. That's not going to happen overnight. The medical community will have to cooperate by expanding the number of facilities who accept Medicaid assignments. I've never seen so media anxious to trash a new  program in my entire life..

rainnnn7
rainnnn7

With regular insurance policies, there is a penalty for using the ER--the copay costs more. That encourages people to go to Immediate Care facilities or their regular doctor. Maybe the new patients aren't being educated or have no such reason to avoid the ER. That would be a glitch in the program. The whole idea though of getting everyone basic coverage was preventative care. It's too early to say how that will be impacted. Someone who has not been monitoring their bp won't instantly get results just by having insurance.

molson
molson

People on Medicaid know that the visit to the ER will not cost them anything so they will go if they think that there is any chance something is wrong (not great for tax payers).  People with no insurance will hold off till the last minute, until they are positive they need to go, because they know it will come out of their own pockets (not necessarily a great thing for them).  The best would be somewhere in-between, like we have with many traditional insurance plans, where a visit to the ER is going to hit you in the pocket book, but not as bad as if you had no insurance.  In reference to the article i'm not surprised at all that giving people medicaid increases costly ER visits, it's free for them.

persuter1
persuter1

This article is missing a rather huge bit of context - does *only* ER usage go up, or does *all* medical usage go up? If all medical usage goes up, the fact that ER usage goes up is hardly surprising. This is like saying "if you give people more food stamps, more food stamps will be used to purchase cigarettes". Well, OK, but that's just a corollary of the fact that some are already used to purchase cigarettes. 


Anyway, I'm not sure I see this as worrisome at all. Medicaid already includes copays for emergency room treatment for non-emergency services, but they are quite low, even for low-income people - if you crank up those copays, ER usage for non-emergency services will decline. I have no concern over increased usage of ERs for emergency treatment, that's exactly what you want to see. Ignoring emergency conditions does not lead to cheaper medical outcomes - I'd rather pay for setting a broken bone than pay for a lifelong disability because the bone didn't heal properly. 


Not to mention that this is at least partially due to decades of telling poor people that they have free access to health care in the ER. Romney, McCain, and Bush all said that. When you push people into ERs, don't be surprised when they keep going there even after they have access to other kinds of health care. 

SamuelClemens
SamuelClemens

Very poor analysis. First it is statistically questionable to extrapolate the results from one possibly unique area to national results. Secondly is the time factor.


Obviously those who previously had only the ER will not suddenly change behaviors or find new doctors, which is not easy to do on Medicaid. That truly may be the story. But with time and availability a shift may well occur which is outside the scope of the study but not the article's speculation. In fact it raises interesting policy issue whether a more aggressive delivery of health care in community settings would be warranted. If Obama's failures, especially in banking and housing, have one thing in common, it is trusting far too much to the big businesses with established power to do public good while in fact all they do is feed at the public trough and make things worse for the rest of us.

healthinsuraceisgood
healthinsuraceisgood

This article was informative and makes it apparent that people new to health insurance coverage need to be taught how to use the new coverage. As a professional in the health care industry I often explain to new clients how to use their coverage to maximize the benefits and minimize their costs. Health insurance can be complicated and those new to it must be taught how to use it.

NickConner
NickConner

If this proves true, definitely not a good thing. That said, my first thought is not "see! new healthcare sucks!". My first thought is..."OK so people obviously need healthcare, but they are probably used to going to ER since other options haven't been available."


How do we get newly insured going through channels that make the most sense once they have access to coverage and can use more affordable options like doctors and specialists (and get better care for their buck on top of it)?

MarthaLima
MarthaLima

That's funny, the article I read yesterday said that it MAY increase ER visits. So which one is it? It will or it may? No one knows for sure because you can't depend on one study of one state which includes people that won medicaid thru a lottery, We don't know if they were properly informed on what to do in case an emergency arose. maybe they were told by the nurse at the dr's ofc go to the ER because we don't have an urgent care. or they simply hadn't chosen a dr yet.  All this fear mongering is really annoying.  

reggiel4204
reggiel4204

@StephenMeier The results of an 18 month study or the findings of a study conducted over several years, which would you choose as a scientist? You should be biased toward the longer term study unless you are biased concerning the ACA....o wise one!?#

grape_crush
grape_crush

@cent-fan

Actually...

"Since not all health care providers accept Medicaid coverage, and not all Americans live in an area with a wide range of medical options, the law invests $11 billion in Community Health Centers. $9.5 billion is designated as operational support to sustain, improve and expand existing community health centers, allowing them to serve more patients. Unfortunately, some of these funds were slashed during a 2011 budget deal with Republicans and cut even further under sequestration"

grape_crush
grape_crush

@ApostasyUSA

Link to the original ThinkProgress article.

Not that who wrote it makes one whit of difference to the point of the article, which is that concern over ER visits is a non-troversy and that the Oregon study cited isn't the be-all end-all of the matter.

Please provide a link to the source next time, Apostasy. You'll still get wingnuts dismissing it because it's not part of their epistemically-closed information system, but at least the rest of us can more easily form an opinion on the piece.

NaveedXVO
NaveedXVO

@ApostasyUSA Hacks everywhere I know. Where did you get these left wing talking points from anyways? LOL and time is as left as they come. You got this from Daily Kos or Jezebel right?

bbbenny
bbbenny

when you put quotes around your post you should provide a link or a reference. 

bbbenny
bbbenny

@sixtymile randomized prosepctive studies are the generally considered to be the gold standard and in general their results trump retrospective studies, non-randomized studies or meta-analyses.

RogerLamb
RogerLamb

@grape_crush

Excellent questions. I do believe the study is correct though. If we suddenly add millions to Medicare/Medicaid, and the Physicians, and the hospitals don't accept the patients because of the problems with payment they already have with those plans, then emergency room visits will actually increase. Remember, millions were cut off of their plans and placed in Medicare.

evankerry
evankerry

@SmoothEdward1 train the people edward! you sound mental

SmoothEdward1
SmoothEdward1

@rainnnn7 I agree. Changing established ways of doings things for the poor is no different than doing it for people with money. Emergency Room care will have to be disincentivized. Going to take time.


aztecian
aztecian

@persuter1this article sounds like a faux news reporting.  missing many details, not very factual.

NaveedXVO
NaveedXVO

@healthinsuraceisgood And why would they stop using free ER care when they don't have to? Seems to me they've made the logical choice. Now you're talking about rationing.

NaveedXVO
NaveedXVO

@MarthaLima Actually this article cites a study of 25k people so I'd say this one is more credible.

ApostasyUSA
ApostasyUSA

@NaveedXVO

I know right!!!  but these aren't left wing talking points. they are the findings found in other studies that were conducted over many years.  

The absolute desperation of Republicans these days is so boring. 

The facts are out there. just because right wingers believe in truth by repetition doesn't mean everyone else is as gullible. 

sixtymile
sixtymile

@bbbenny@sixtymile They are a randomized set of winners, but "winners" are an exceptional group not a neutral sample. As "winners" they may be conditioned to benefit from their winnings, which would mean utilizing the healthcare opportunity they have gained. It remains to be seen if a similar result would confirm this study or not.

jmac
jmac

@RogerLamb @grape_crush It was a problem in the military when I was growing up and really bothered the doctors when someone came to the emergency room for a sore throat.    But I don't see why there can't be a solution that can be worked out.  

SmoothEdward1
SmoothEdward1

@evankerry You think people can't be taught other behaviors because they are poor? You're the one who sounds mental. Bigoted, too.

bbbenny
bbbenny

@aztecian @persuter1 if you want facts you should read the original article. All of the news coverage is doing is sensationalizing the predicable fact that giving away access to healthcare with little to no personal responsibility for the costs will result in the covered individuals choosing the path of least resistance which is to get their routine problems taken care of in an er environment.  The er or urgent care setting doesn't require planning and is available 24/7. Unless there is a form of negative reinforcement for improperly using emergency services there will be no change in behavior.

RogerLamb
RogerLamb

@aztecian@persuter1 

Wow, just because you disagree you automatically assume right wing bias? Time is definitely a Liberal News Paper. Now that the media is no longer giving this administration a free pass you may find lots of articles your obvious bias will cause you to dislike. 

Medicare services are limited, Doctors don't like the rate of the payments and the paperwork involved. Putting people on that program without dealing with the underlying faults in the program itself was a major mistake. Big Government can't run these things efficiently.

grape_crush
grape_crush

@ApostasyUSA > Get a life dude...

If you're going to copy-paste something, at least have the courtesy to link back to the source, dude

If you're going to reply to someone's comment, at least have the courtesy to read what they wrote, dude.

Then again, if you want to be seen a plagiarizing dckhead to people that are agreeing with you, dude, it's your own sad business.


ApostasyUSA
ApostasyUSA

Get a life dude or become an editor or something.


grape_crush
grape_crush

@ApostasyUSA

Also, that's not where you got the text you quoted from, is it?

...Amateurs...

grape_crush
grape_crush

@ApostasyUSA@grape_crush  > Now go back to Faux Newts or Rush Limba-ba and find another way to sustain your disdain for the so called "liberal".

May want to read what I wrote a little more closely there, bud, and learn to control that knee-jerk reaction.

reallife
reallife

@SmoothEdward1 @evankerry i think you're right... we need some indoctrination camps... that always worked before