Emergency room visits ticked up in states that expanded their Medicaid programs under the Affordable Care Act, and concurrently, payer mixes changed, with more of those patients having insurance, according to a new study from the Annals of Emergency Medicine.
After 2014, when the ACA's Medicaid expansions took effect in participating states, those states saw an 8.8 percent increase in the number of Medicaid-covered ER visits. At the same time, ER visits by the uninsured dipped 5.3 percent.
That's been beneficial to hospitals, which have seen reductions in uncompensated care and overall improved financial performance, the analysis showed.
The results jive with recent research from the Oregon Health Insurance Experiment, which evaluated the effect of expanding Medicaid to low-income adults, That study found a positive and sustained effect of Medicaid coverage on ED visits.
Other research has shown contradictory results, including studies on health reform efforts in Massachusetts; many of those findings suggest that the coverage expansion led to a reduction in ED visits by improving access to outpatient care. The authors of this most recent study explain the discrepancies in prior reporting by pointing to heterogeneity among expansion states in terms of coverage changes. They analyzed patients in 25 states -- 14 that expanded Medicaid, and 11 that didn't.
The percentage of ER visits covered by insurance stayed stable for expansion states, but increased noticeably in non-expansion states. Most of the gains in insurance in those non-expansion states were in private coverage rather than Medicaid.
Overall, Medicaid expansion had more of an impact in areas where more people were expected to gain coverage, the authors said. The change in total visits was about twice as large in states like Kentucky, where most childless adults were ineligible for Medicaid at any income level before 2014; in states like Hawaii, the impact was much lower, and childless adult Hawaiians above the poverty line were already eligible for Medicaid.