Dive Brief:
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A new Annals of Emergency Medicine report found that Medicaid expansion under the Affordable Care Act (ACA) led to 2.5 more emergency visits per 1,000 people after 2014. Uninsured visits to the ER decreased by 5.3%.
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The study analyzed patient visits in 25 states, including 14 that expanded Medicaid and 11 that didn't. The share of visits by patients with private insurance remained the same for expansion states and increased by several percentage points for non-expansion states.
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ER visit increases were largest for injury-related visits.
Dive Insight:
The study’s lead author, Sayeh Nikpay assistant professor of health policy at Vanderbilt University, said the impact of Medicaid expansion varied greatly depending on the state. For instance, Kentucky, where most childless adults were not eligible for Medicaid at any income level before 2014, doubled the number of total visits compared to Hawaii, which had allowed childless adults above the poverty line to get Medicaid.
In an accompanying editorial, Dr. Ari Friedman, a fellow in emergency medicine at Beth Israel Deaconess Medical Center, said an increase in ED visits by Medicaid beneficiaries isn't necessarily good or bad. "Insurance increases access to care, including emergency department care. We need to move beyond the value judgments that have dominated so much study of ED utilization toward a more rational basis for how we structure unscheduled visits in the health system," he said.
The study findings are not surprising. ED usage in general increased after the ACA was implemented. Other research has found Medicaid expansion reduced average travel time to EDs as well. Emergency medicine does cost more, but with more emergency patients insured, hospitals aren't on the hook for as much uncompensated care.
Advocates for Medicaid expansion could trumpet this latest report as reason for not rolling back Medicaid expansion. In May, the House narrowly approved the American Health Care Act, which includes cutting billions from Medicaid and rolling back expansion. The Senate is currently working on its own health reform bill. Also, President Donald Trump’s proposed $4.1 trillion budget plan seeks to make $610 billion in Medicaid cuts.
Medicaid expansion has benefited states that have tried it in more ways than just lowering the number of uninsured. Many of the 19 expansion have reported improved access to care and shown better coordination and integration. Their economies are also doing better, and experts have said Medicaid expansion played a part.