- New Medicaid patient in states that expanded the program under the Affordable Care Act increased hospital visits on average by about 20%, mostly with outpatient visits to the emergency department for deferrable conditions, according to new research from the Brookings Institution.
- Expansion did end up generally being well-targeted, meaning those receiving better access to services were those who previously had the highest unmet needs. Expansion under the ACA was more target efficient than previous attempts to broaden the program's eligibility, the authors wrote.
- Changes, however, varied largely among expansion states, they said. That can be attributed to differences such as a state's demographics and previous trends in uncompensated care.
Numerous studies have shown the benefits of Medicaid expansion in health outcomes, state economic performance and other areas. The latest research sheds light on how specific policy implementations of Medicaid expansion affected patient access and behavior.
Researchers, a panel of health economists, used Agency fro Healthcare Research and Quality data from 20 states for 2012 to 2015, looking at outpatient and inpatient emergency visits as well as hospitalizations that originated in the ED.
They characterized the ACA's changes to Medicaid as the "largest and most non-controversial expansion" of the program that "fundamentally changed the concept of Medicaid eligibility."
They noted that policymakers arguing for the ACA when it was being debated in Congress often said its changes would allow more people to get care in the proper primary care setting instead of more expensive emergency rooms. Their findings show ED visits didn't in fact drop, but numerous variables have affected those outcomes.
Previous research has shown that the number of ED visits overall has been increasing, rising nearly 10 million in 2016 to 145.6 million. But in contrast to the latest findings, usage fell for patients with nonurgent medical symptoms, according to the Centers for Disease Control and Prevention.