- Emergency room use among Oregon Medicaid patients remained high two years after people gained coverage, according to a study published Thursday in the New England Journal of Medicine.
- The high ER use persisted even as newly covered Medicaid patients visited physician offices as well.
- Policymakers had expected ER volumes to drop as more patients gained access to primary care.
The findings come from Oregon, which expanded its Medicaid program in 2008 through a lottery system. An earlier study found ER visits increased 40% in the first 15 months after people enrolled through the lottery, but experts speculated the spike would disappear once patients established relationships with primary care doctors.
That wasn’t the case, as the new study shows. Looking at ER use in six-month integrals over two years, the researchers found Medicaid coverage grew the mean number of ER visits per person by about 0.17, or by about 65% compared with the control group (patients who had not won the lottery) in each six-month period.
The researchers speculate that people who gain Medicaid coverage are likely to increase use across a number of care settings, including the ER. It’s also possible their primary care doctor may be sending them to the ER for higher-level care.
The Affordable Care Act allows states to expand their Medicaid eligibility to nearly all low-income people who earn less than 138% of the poverty level. However, as of September, 19 states had not opted to do so, according to an issue brief by the Kaiser Family Foundation. That leaves more than 2.5 million low-income adults in a “coverage gap” because their income exceeds current Medicaid eligibility but is below the floor for ACA marketplace premium tax credits, the brief says