Medicaid Expansion Increases Emergency Room Visits

One of the arguments made in favor of measures to expand health insurance coverage, including the Medicaid expansion, was that the lack of insurance coverage leads many individuals to seek medical treatment in emergency rooms, and that this results both in higher health care costs and in cost-shifting, as the uninsured may be unable to pay for the cost of the care they receive.  Some health care wonks were always skeptical of the first argument, however, noting that insurance coverage is not a particularly good predictor of emergency room utilization.  Indeed, there were reasons to believe that increasing insurance coverage would actually increase emergency room utilization.  If so, a consequence of increasing coverage would be to increase overall health care expenditures and, insofar as expanded coverage is achieved through Medicaid, increase the cost-shifting (a point I made here).  Sure enough, a new study finds that one effect of expanding Medicaid coverage is to increase emergency room visits by covered populations.  This does not necessarily mccean expanding coverage is a bad idea, or that it’s not worth the cost — just that some of the arguments made in favor of expanding coverage were based upon wishful thinking.

For more on the study, and its implications, see Wonkblog, Reason, and TIE.

UPDATE: Harold Pollack comments:

We can’t say from this paper whether the extra ED visits were valuable or cost-effective. We can say that these results will embarrass some liberal advocates who argued that expanded coverage would reduce overall rates of ED use.

It should. This talking point was never properly evidence-based or even particularly plausible given prior research. It’s not obvious that reducing the rate of ED use is even a sensible policy goal. Advocates across the political spectrum should stop using the ED for cheap talking points about the mythical savings associated with universal coverage or about the misbehavior of Medicaid recipients who supposedly waste huge amounts of money through overuse.

We might, instead, take some satisfaction that we have created a system, open 24 hours per day, 365 days per year, which people turn to when they need help. Our challenge is to make this system work.

FURTHER UPDATE: Health care wonks may not be surprised by these findings, but political operatives must be.  Indeed, just yesterday the Democratic Legislative Campaign Committee sent out a fund-raising e-mail claiming that the expansion of health insurance coverage under the PPACA will mean reduced ER visits and cost savings.

Nearly 7 million Americans’ new health coverage went into effect. Those 7 million Americans can now go to the doctor when they’re sick, and their Emergency Room visits will no longer have to be paid for through higher prices for everyone else.

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