Here’s what critics mean when they say the Affordable Care Act is simply cementing the dysfunctional U.S. health care status quo: two new studies suggest emergency room use is spiking in the wake of the law’s expansion of insurance coverage. First, the Colorado Hospital Association looked at 450 hospitals across 25 states and found that states that expanded Medicaid saw average ER use go up by 5.6 percent over the same period last year—three times more than states that did not expand. That may not seem like a lot, but if those patients had used urgent care clinics or community health centers instead, the difference in cost would have amounted to some significant savings.This finding is consistent with a second study just released—this one on the young adults. Stanford University researchers found that young adults whom the ACA allows to stay on their parents insurance for longer treat the ER as a primary care setting, via WaPo. The researchers compared those under 26, who could stay on their parents’ insurance, with those over 26, who could not. They found that though overall number of ER visits were two percent lower for the older group who didn’t get the expansion, the same number of people overall used the ER in both groups:
The distinction here is that young adults with chronic conditions, who have greater care needs, probably now had better access to non-ER care settings, so their number of visits to the ER decreased. But the finding also suggests that healthy young adults, who might have shunned health insurance before, still continued to see the ER as a place for seeking out routine care, according to the study. Further, insurance likely makes those ER visits cheaper, which could actually increase how much people use the ER, the researchers wrote.But everyone agrees that in an ideal health-care system, the ER wouldn’t be a place for routine care.
Expanding insurance coverage is a worthy policy aim but unless we change how and, crucially, where patients receive care, we will be stuck with a system much more expensive and less efficient than it could be.