Misunderstanding Of Medicaid And Emergency Room Use

There has been a surprising amount of attention to a recent study showing that if you give people Medicaid coverage they will go to the Emergency Room more often than if they did not have coverage. That should hardly come as a surprise. If someone has to pay, they will be far more reluctant to go to the Emergency Room where they will build up a huge bill.

Much of the attention is coming from conservative sites who misunderstand the issue (or are intentionally engaging in distortion), and claim that this shows a fault in Obamacare.

Discussion of Emergency Room use in the past was often centered around the conservative claim that the uninsured poor are not without health care coverage because they can go to the Emergency Room when sick. The usual response is that ER care is far more expensive than other out-patient care and is a poor source of treatment for chronic medical problems. Plus the poor cannot really go to the ER on a routine basis without running up a huge debt.

Provide Medicaid or private insurance, and use of the ER will increase. Many patients with both private coverage and Medicaid abuse the ER for a variety of reasons. There is certainly no reason to believe that Medicaid patients will be any less likely to do so.

Reducing over-use of the ER requires additional measures. To some degree this should improve as more of those with newly-received Medicaid become better established with primary care physicians. Simple educational measures and Medical Homes would bring about a further decrease in ER over-use. A study such as this of people who only recently received Medicaid would be expected to show greater 0ver-utilization in early years.

These simple measures will not eliminate over-utilization of emergency rooms for non-emergency visits. If this is the goal, Medicaid programs would need to utilize further measures often used by insurance companies to reduce over-utilization. This might include significantly higher co-pays for ER versus other out-patient visits, either for all visits or for only non-emergency visits. A more extreme practice used by some plans is to require prior-authorization from either the insurance company or the patient’s primary care physician before an ER visit before the visit would be covered. (Of course exceptions need to be made for true emergencies. We do not want people with chest pain to have to waste time getting approval before seeking medical attention, and insurance companies cannot deny payment because someone is unconscious and unable to seek authorization.)

Long run there are potential cost savings in providing Medicaid coverage which ultimately leads to people seeing primary care physicians and receiving preventative care as opposed to episodic care from Emergency Rooms. However it would take years to see the benefit from this. The goal of Medicaid expansion is to provide care to those who are not receiving care, not simply to save money. Denying medical care and letting people die younger might save more money, but is not a desirable public policy agenda.