The percentage of uninsured patients who visited hospital emergency departments or were discharged declined between 2006 and 2016, according to a new JAMA study.
The proportion of ED visits by uninsured patients dropped from 16% in 2006 to 8% in 2016. Uninsured patient hospital discharges dropped from 6% to 4%. For patients between 18 and 64, ED visits declined from 20% to 11% and discharges from 10% to 7%.
The report credited the Affordable Care Act for the decline, as well as recent trends like new payment rules and models, patient-centered medical homes, expanding quality measurement and growing hospital ED alternatives such as urgent care clinics, freestanding emergency rooms and telemedicine.
The study authors, who analyzed 1.4 billion ED visits and 405 million discharges, said they discovered a link between implementation of the ACA — as well as recent trends in payment reform — and lower uninsured ED and hospital visits.
At the same time that uninsured hospital visits declined, Medicaid patient visits increased, the study found. Medicaid expansion under the ACA provided a health insurance option for about 15 million Americans.
The authors found signs of hope in the results but warned that uninsured patients still make up many hospital visits. "This suggests that continued attention is needed to address the lack of insurance in US hospital visits, particularly among people aged 18 to 64 years who have less access to government-sponsored insurance," they wrote.
The report's positive findings about the ACA comes as the Trump administration is hoping that the courts will toss the law. The administration in March changed its stance and argued in a court filing that the entire law should be eliminated rather than just its pre-existing condition protections.
Meanwhile, JAMA study's findings point to less uncompensated care for hospital EDs — good news for facilities struggling with their margins.
A different JAMA study recently found that rural EDs, especially at safety net hospitals, are struggling with more visits. Rural ED visit rates increased by more than 50% between 2005 and 2016 despite a 5% population drop. Rural ED use grew among multiple patient populations, including Medicaid and uninsured patients.
Overall, ED visits are increasing, though nonurgent visits have fallen. Recent data from the Centers for Disease Control and Prevention showed ED visits grew by almost 10 million patients in 2016 compared to the previous year. However, patients who used EDs for regular care decreased from 5.5% in 2015 to 4.3% in 2016. Wait times also dropped.