A critical aspect of the Affordable Care Act is the expansion of Medicaid, the government insurance program for the poor. Under ACA, individuals who make up to 138 percent of the federal poverty level ($23,550 for a family of four) qualify for free health care.
Those in favor of the expansion say it extends the safety net for the poorest among us who cannot afford health insurance. That’s true, and clearly there are benefits, particularly for those included in the expanded coverage.
Currently, the uninsured often seek treatment at hospital emergency rooms, which is the most expensive and least efficient form of care. The hope by ACA supporters is that once people have insurance, they will bypass the ER and go to a family doctor or a clinic where the care would be less expensive.
However, new research says just the opposite will happen; Medicaid patients will actually go to the ER more often.
The study, published in the journal Science, looked at Oregon’s Medicaid program, which expanded coverage through a lottery system in 2008. A review of over 25,000 people in the Portland area on Medicaid found emergency room visits increased by 40 percent.
A big reason for the increase is that patients went to the ER for non-emergency medical treatment.
“Emergency department use increased even in classes of visits that might be most substitutable for other outpatient care, such as those during standard hours and those for ‘non-emergent’ and ‘primary care treatable’ conditions,” the report said.
Additionally, the study found that even though people went to the emergency room more often, their health didn’t improve that much. There were fewer cases of depression, but physical health—blood pressure and cholesterol—remained the same.
Some of this is just basic economics; if a valued service is “free,” people will use it more. If there’s no cost difference to the patient between the emergency room and the doctor’s office, there’s no incentive to not go to the ER.
Also, people who have not had insurance and have no family doctor may be used to going to the ER for their care. Perhaps that will change over time as people become accustomed to having coverage, but the Oregon study shows patients do not automatically make the switch, or they may be having trouble finding a family doctor that will take new Medicaid patients.
Regardless, the research further undermines the argument that Obamacare will bend the health care cost curve. If anything, the so-called free care that millions more Americans are receiving will drive costs even higher.