ER use skyrocketing with Obamacare?

posted at 3:01 pm on June 9, 2014 by Ed Morrissey

Not a new observation, but this report from the Courier-Journal shows that the increase in emergency-room usage is not just a one-time spike. Supposedly, the need to reduce the number of people getting normal care through emergency-room visits contributed to the fierce urgency of now in passing ObamaCare to revamp the entire health-insurance industry. Instead, ERs are seeing a sharp increase in normal-care access, due in large part to the new coverage in ObamaCare and a lack of understanding of the problem from the beginning:

That 12 percent spike in the number of patients — many of whom aren’t actually facing true emergencies — is spurring the hospital to convert a waiting room into more exam rooms.

“We’re seeing patients who probably should be seen at our (immediate-care centers),” said Lewis Perkins, the hospital’s vice president of patient care and chief nursing officer. “And we’re seeing this across the system.”

That’s just the opposite of what many people expected under Obamacare, particularly because one of the goals of health reform was to reduce pressure on emergency rooms by expanding Medicaid and giving poor people better access to primary care.

Instead, many hospitals in Kentucky and across the nation are seeing a surge of those newly insured Medicaid patients walking into emergency rooms.

Three weeks ago, Bloomberg reported on the same phenomenon:

The issue isn’t merely a burst of enthusiasm from newly-covered users, although that’s part of the problem. New coverage has created more demand, as was easily predicted, but did nothing to address supply. In fact, thanks to the attempt to save money on reimbursements, the supply of providers who will take new Medicaid customers has shrunk considerably — and not just in Medicaid, either. We have seen plenty of media reports of bronze-level plans that have almost no realistic provider options for consumers without having to drive an hour or more to get to a physician, or where the provider network turned out to include many doctors who aren’t participating at all.

What happens when one amplifies demand and discourages supply? In this case, a lot of people discover that their only option is the emergency room. And since they have their own coverage, they flock to the ERs rather than access a clinic with their own resources, and are much more likely to seek access.

One doctor hit on the perfect description of ObamaCare:

“It’s a perfect storm here,” said Dr. Ryan Stanton of Lexington, president of the Kentucky chapter of the ER physician group.”We’ve given people an ATM card in a town with no ATMs.”

What’s more, the data available at the time of the ObamaCare debate in Congress easily predicted this outcome:

A 2007 issue brief from the Kaiser Family Foundation said Medicaid patients made up 9 percent of the general population at the time but accounted for 15 percent of emergency visits. Researchers concluded that the most frequent users weren’t substituting ERs for primary care, but rather suffered from chronic conditions and required more health care in general.

A January study in the journal Science found that getting covered under Oregon’s 2008 expansion of a Medicaid program for uninsured adults increased ER use by 0.41 visits per person, or 40 percent relative to visits among a control group. All sorts of visits went up — those for serious problems, as well as “for conditions that may be most readily treatable in primary-care settings.”

As Bruce McQuain notes today at QandO, this outcome was predicted by ObamaCare critics, but dismissed by the media and Democrats. Chalk the pledge to reduce ER access up to the same pledge board as “you can keep your plan,” “you can keep your doctor,” and “we’ll lower premiums by $2500 a family.”


Related Posts:

Breaking on Hot Air

Blowback

Note from Hot Air management: This section is for comments from Hot Air's community of registered readers. Please don't assume that Hot Air management agrees with or otherwise endorses any particular comment just because we let it stand. A reminder: Anyone who fails to comply with our terms of use may lose their posting privilege.

Trackbacks/Pings

Trackback URL

Comments

“We’ve given people an ATM card in a town with no ATMs.”

Heh.

Bitter Clinger on June 9, 2014 at 3:05 PM

Who woulda guessed this would happen?

Oh ya – WE did.

dentarthurdent on June 9, 2014 at 3:06 PM

Cloward-Piven baaibaayy…

burrata on June 9, 2014 at 3:06 PM

Winning!

cmsinaz on June 9, 2014 at 3:06 PM

this outcome was predicted by ObamaCare critics

IIRC, the same thing happened in Massachusetts ERs after Romneycare was adopted there.

Of course Medicaid patients are going to use ERs more than necessary. After all, they’re not paying the ER bill, so why should they care?

AZCoyote on June 9, 2014 at 3:07 PM

Who would have thunk it…
predictable

bazil9 on June 9, 2014 at 3:07 PM

No, no!!!

Wasn’t it supposed to be the electric rates that would skyrocket?

Dagnabit!

RedPepper on June 9, 2014 at 3:09 PM

Oh ya – WE did.

dentarthurdent on June 9, 2014 at 3:06 PM

The libturd elite knew this would happen. They want the system to crash so they can have single payer.

dogsoldier on June 9, 2014 at 3:09 PM

So where is old everpisso/lester to blame this on republicans? Did OFA stop filling his EBT card.

HumpBot Salvation on June 9, 2014 at 3:10 PM

Unexpectedly…

jjjdad on June 9, 2014 at 3:11 PM

New coverage has created more demand, as was easily predicted, but did nothing to address supply.

So free birth control for sluts is not working ?

burrata on June 9, 2014 at 3:11 PM

Instead, many hospitals in Kentucky and across the nation are seeing a surge of those newly insured Medicaid patients walking into emergency rooms.

The Bronze Plan discourages this, by making you pay a big co pay. If it is OK for the Bronze Plan, then, why don’t we use it for Medicaid? If you have Medicaid, they will bill you a co pay, and you can keep paying it until you pay it off. Then you might take your ordinary complaint to the doctor on a weekday.

Fleuries on June 9, 2014 at 3:13 PM

Pro-tip: If you choose not to call an ambulance and can make it there in a real emergency, call 911 from the ER parking lot. More and more people are using the ER as their de facto primary care. If you want to get triaged ahead of all the knuckleheads with sniffles or a hangnail, don’t sit in the waiting room for your turn or Death, whichever comes first.

Christien on June 9, 2014 at 3:16 PM

Maybe if we offered amnesty to illegals and tried to draw even more in that would help.

Flange on June 9, 2014 at 3:17 PM

Illegals, terrorists, deserters, takers, non-producers, please go to the front of the line for free immediate service…

Everyone else, you’re screwed…

PatriotRider on June 9, 2014 at 3:17 PM

Then you might take your ordinary complaint to the doctor on a weekday.

Fleuries on June 9, 2014 at 3:13 PM

On the provider side of that scenario, depending on where you live, reimbursement rates via Medicaid generally tend to be so low that docs can’t take the losses in revenues. So they don’t see Medicaid patients.

lineholder on June 9, 2014 at 3:19 PM

Solution to this problem: close down all ERs.

burrata on June 9, 2014 at 3:23 PM

As Bruce McQuain notes today at QandO, this outcome was predicted by ObamaCare critics, but dismissed by the media and Democrats.

Excuse me, Ed, but the media IS Democrat. They are one and the same.

MN J on June 9, 2014 at 3:24 PM

Gosh, this Obamacare is just swell on so many levels.

Cindy Munford on June 9, 2014 at 3:25 PM

Solution to this problem: close down all ERs.

burrata on June 9, 2014 at 3:23 PM

Or simply use the ER for it’s intended purpose … emergencies. It shouldn’t be too hard to determine if someone’s problem is emergent.

darwin on June 9, 2014 at 3:26 PM

What happens when one amplifies demand and discourages supply?

A flourishing of unicorns? More Michelle Obama sightings? I don’t know what you’re asking of me. How can I answer questions if you don’t give me multiple choices?

dreadnought62 on June 9, 2014 at 3:26 PM

These guys (newly covered) are just trying to show us all that it doesn’t matter who your doctor is.

Cindy Munford on June 9, 2014 at 3:27 PM

My neighbors coworker was having a heart attack,presented to the local ER and the wait was so long he called 911 from the ER and got an ambulance to take him to another hospital.

docflash on June 9, 2014 at 3:27 PM

Supposedly, the need to reduce the number of people getting normal care through emergency-room visits contributed to the fierce urgency of now in passing ObamaCare to revamp the entire health-insurance industry. Instead, ERs are seeing a sharp increase in normal-care access, due in large part to the new coverage in ObamaCare and a lack of understanding of the problem from the beginning:

Once again, the anti-Midas effect.

rbj on June 9, 2014 at 3:27 PM

lineholder on June 9, 2014 at 3:19 PM

Correct

bazil9 on June 9, 2014 at 3:29 PM

In my experience, those with Medicaid and to some degree those with no coverage aren’t the most foresighted people in society, either: hence, they show up when they are ‘on fire’, rather than six months earlier when they merely smelled the smoke.
Guess how they typically vote?

orangemtl on June 9, 2014 at 3:29 PM

The exact reverse of what obama’care’ was meant to do.

Schadenfreude on June 9, 2014 at 3:29 PM

One of these days Americans are going to wake up and state, “we don’t need no stinking insurance. If the illegal immigrants have free rein of our hospitals and clinics and don’t have to pay, why should the rest of America?”
The hospitals have no one to blame but themselves. They were in bed with Obama pushing this disaster, so now they should live with their consequences. I would have loved to see the GOP denounce the doc fix and inform people that Obama was supposed to fix that problem, too. But, the weak kneed Republicans don’t know how to fight and pander to the liberal media.

djaymick on June 9, 2014 at 3:30 PM

What happens when one amplifies demand and discourages supply?

I don’t know what happens, but this question is racist.
I know that much.

burrata on June 9, 2014 at 3:33 PM

The Obamacare mega disaster that is getting worse by the hour… Everything the welfare queens agitator and his band of fools said about Obamacare was a lie, everything…

mnjg on June 9, 2014 at 3:35 PM

Holy Crap these people are stupid.

forest on June 9, 2014 at 3:35 PM

My neighbors coworker was having a heart attack,presented to the local ER and the wait was so long he called 911 from the ER and got an ambulance to take him to another hospital.

docflash on June 9, 2014 at 3:27 PM

I’m guessing he wasn’t yelling in meheecan and waving his EBT card at the nurses passing by ?

burrata on June 9, 2014 at 3:36 PM

darwin on June 9, 2014 at 3:26 PM

Unless I’m mistaken, under EMTALA, ERs can’t turn them away for being nonemergent. They can transfer a patient to another facility to be treated, after triage, if the hospital doesn’t provide the scope of services needed by the patient. But they can’t deny access to care.

You’d be surprised at the number of dental infections that get treated in the ER.

If we set up more nonurgent medical centers…that might be an option. We had a doctor’s office who did there locally two years ago….expanded their service hours for nonurgent from 5 p.m. to 5 a.m., 7 days a week. Brought in the staff to do it. Gave the local community another option beside the ER.

lineholder on June 9, 2014 at 3:37 PM

yet another unexpected outcome! Who would have guessed?

rjoco1 on June 9, 2014 at 3:46 PM

Unless I’m mistaken, under EMTALA, ERs can’t turn them away for being nonemergent.

lineholder on June 9, 2014 at 3:37 PM

Well if Congress wrote the law they can change the law. Since everyone has insurance supposedly there’s ample justification for doing so.

darwin on June 9, 2014 at 3:54 PM

Supposedly, the need to reduce the number of people getting normal care through emergency-room visits contributed to the fierce urgency of now in passing ObamaCare to revamp the entire health-insurance industry

“We’re seeing patients who probably should be seen at our (immediate-care centers),” said Lewis Perkins, the hospital’s vice president of patient care and chief nursing officer. “And we’re seeing this across the system.”

Low Information Voters are “takers”; are morons; are wrecking the Republic.

socalcon on June 9, 2014 at 3:54 PM

Holy Crap these people are stupid.

forest on June 9, 2014 at 3:35 PM

Those that ‘passed the law to see what was in it’?

Those that stripped a House bill at midnight to get it through the Senate?

Those that can’t tell if their ‘illness’ is an emergency?

Or, all of the above?

socalcon on June 9, 2014 at 3:57 PM

I just love all the morally superior libs (medical and non medical) lecturing all us bitter clingers about how evil we were to force medical care through emergency room care. Nary a word NOW you dumb as_ _s. You were wrong then and you are wrong now.

warmairfan on June 9, 2014 at 3:59 PM

This is just the opposite of what Obama promised, so it looks like he lied again.

If you think ObamaCare is a mess, just wait until amnesty is passed. If the government can’t run health care, how is it going to process 12-25 million illegal immigrants?

bw222 on June 9, 2014 at 4:01 PM

Instant death panel – you die in line.

(or is that instant VA?)

formwiz on June 9, 2014 at 4:07 PM

Or simply use the ER for it’s intended purpose … emergencies. It shouldn’t be too hard to determine if someone’s problem is emergent.

darwin on June 9, 2014 at 3:26 PM

Speaking as someone who worked as a volunteer EMT in western Maryland, that will NEVER happen. It does not matter if you have a hangnail, if you call for an ambulance, we will do our damndest to make you go to the ER.

If you for some reason refuse our care when we show up, there is a long list of questions we must ask and forms for the patient to sign before we’ll leave.

Of course, anyone with half a brain can figure out the reason for this is fear of lawsuits. There have been cases where some EMTs have downplayed the PT’s complaints and left. Well, you can figure out the rest. Hence the questions and forms.

Same thing in the ER. The hospital doesn’t want lawsuits so they’ll take you. You just might have to wait forever, but they’ll see you.

And for those who think they will be seen quicker if they come in an ambulance, you might be seen a teeny weeny bit quicker, but if the triage nurse determines that a hangnail isn’t a life threatening emergency, off to a gurney in the hall for you! You might be a little more comfortable lying down, but you won’t get in any faster.

NavyMustang on June 9, 2014 at 4:14 PM

Still waiting for the critics of Obama-democrat care to be proven wrong.

I’m guessing that once Obama reads about this, nobody will be madder than him. That he will start an internal investigation and get to the bottom of why his controversial law is such a bad law.

jukin3 on June 9, 2014 at 4:15 PM

I’m shocked that if you give someone a card for free goodies, that they will actually show up and claim those free goodies. Why didn’t someone foresee this possibility?

A second possibility, -perhaps part of the ‘problem’ is that a trip to the ER is free for someone on Medicaid, but a trip to a doctor office that takes Medicaid requires some effort on the part of the taker, ie a taxi or getting a ride with someone?

slickwillie2001 on June 9, 2014 at 4:41 PM

Obama built that…

Ricard on June 9, 2014 at 4:44 PM

Solution to this problem: close down all ERs.

burrata on June 9, 2014 at 3:23 PM

Or simply use the ER for it’s intended purpose … emergencies. It shouldn’t be too hard to determine if someone’s problem is emergent.

darwin on June 9, 2014 at 3:26 PM

They still don’t go away…they will still sit there in the ER waiting room! And scream ” I’ ll sue if I don’t get get seen”.

Bakokitty on June 9, 2014 at 4:47 PM

You mean people with no skin in the game tend to abuse the system? Huh. Whodda thunk?

Hill60 on June 9, 2014 at 5:00 PM

A few questions here:

1) Why should an ER treat anyone for a non-emergency problem? EMTALA only requires ERs to treat people with actual emergencies, regardless of their insurance. There is nothing in that law that forces an ER to accept a patient who should just go to a doctor’s office. If it’s ambiguous, Congress should fix this ASAP. I don’t think any voters are going to be very sympathetic to people who deep showing up at the ER with a kid who has a common cold.

2) Isn’t this all part of our “gotta have it now” culture? Who wants to wait until tomorrow or the next day to see a doctor about a cough? I’ll just go to the ER.

3) So what if few doctors accept Medicaid? As long as some do, there is no excuse for going to an ER for a non-emergency problem. You have to wait a week or two? Welcome to government health care! You asked for it. Want better insurance with more doctors? GET A JOB.

4) What happens when someone dies while an ER is filled with non-emergency patients?

rockmom on June 9, 2014 at 5:07 PM

My Obamacare ER benefits are noticeably generous, cannot wait to get hit by a car or OD!

Tard on June 9, 2014 at 5:08 PM

My Obamacare ER benefits are noticeably generous, cannot wait to get hit by a car or OD!

Tard on June 9, 2014 at 5:08 PM

Did you read the article? People are clogging the ERs with non-emergency problems. They don’t want to bother finding a primary care doctor or going to a clinic.

So if you DO get hit by a car, you might just die waiting for an exam room and a doc to see you in the ER because they’re all tied up treating Obamacare patients who have sprained ankles and coughs.

rockmom on June 9, 2014 at 5:19 PM

1) Why should an ER treat anyone for a non-emergency problem? EMTALA only requires ERs to treat people with actual emergencies, regardless of their insurance. There is nothing in that law that forces an ER to accept a patient who should just go to a doctor’s office. If it’s ambiguous, Congress should fix this ASAP. I don’t think any voters are going to be very sympathetic to people who deep showing up at the ER with a kid who has a common cold.

rockmom on June 9, 2014 at 5:07 PM

EMTALA requires an assessment. It does not require treatment for non-urgent situations, and doesn’t ensure the treatment is free- but, does prohibit turning people away for inability to pay.

Practically, what this means is folks show up all the time for something they should take to a primary doctor or urgent care center. Those who are responsible & financially secure respond to incentives (such as high ER copays) to take non-emergent needs elsewhere.

Those who do not have such circumstances show up in the ER, may receive a bill in the mail in a few weeks that usually isn’t paid, and may be written off by the hospital as “charity care” later.

If you show up with a health problem requiring stabilizing treatment or admission, though, you should be able to get it.

cs89 on June 9, 2014 at 5:25 PM

If you think ObamaCare is a mess, just wait until amnesty is passed. If the government can’t run health care, how is it going to process 12-25 million illegal immigrants?

bw222 on June 9, 2014 at 4:01 PM

We already know the answer to this. The government will “process” the new amnesty applications in the same way that it “processed” the 1986 amnesty applications, and the more recent DREAM (by illegal EO) applications: just rubber stamp them all “approved.”

AZCoyote on June 9, 2014 at 5:25 PM

Did you read the article? People are clogging the ERs with non-emergency problems….

rockmom on June 9, 2014 at 5:19 PM

Hint: everything I post is sarcasm. Even this!

Tard on June 9, 2014 at 5:31 PM

IIRC, the same thing happened in Massachusetts ERs after Romneycare was adopted there.

Of course Medicaid patients are going to use ERs more than necessary. After all, they’re not paying the ER bill, so why should they care?

AZCoyote on June 9, 2014 at 3:07 PM

No.

To evaluate the effect of the reform on emergency room use, I (Miller 2012a) assumed that counties in Massachusetts with higher uninsurance rates before the reform experienced a larger increase in coverage than counties where most of the population was already insured. Using administrative data on all emergency room visits (including those not leading to a hospital admission) that occurred in Massachusetts between 2002 and 2008, I analyzed the relative change in emergency room use within Massachusetts before and after the reform based on the pre-reform uninsurance rate. I also compared counties in Massachusetts to similar counties in other states over this period. I found that the reform reduced emergency room use by about 5%. Most of this reduction–over 80%–was attributable to a reduction in visits classified as non-urgent or primary care treatable. In contrast, non-preventable emergencies and injuries were not affected by the reform. Consistent with Kolstad and Kowalski (2012), I (Miller 2012a) also found a small reduction in ER visits that result in admission to the hospital, although the effect of the reform on these types of ER visits was not statistically significant in most models. Additionally, the reduction in emergency room visits was largest on week days and smallest overnight and on the weekends, when physicians’ offices tend to be closed, implying that physician availability plays an important role in the use of the hospital ER. This evidence suggests that expanding insurance coverage to the uninsured caused them to use office-based care in lieu of hospital emergency room care for conditions where such substitution is appropriate.

Evidence from survey data also suggests emergency room visits fell modestly. Long, Stockley, and Dahlen (2012) noted that by 2010, the probability of a Massachusetts survey respondent reporting a hospital emergency room visit fell by 3.8%. In particular, the probability of heavy emergency room use (three times or more in the last year) fell by 1.9% and the probability of reporting a non-urgent emergency room visit fell by 3.8%. I (Miller 2012b) similarly found a significant reduction in emergency room visits among children.

The reduction in ER visits following the Massachusetts health reform is surprising because previous research had suggested that expanding insurance coverage would increase, rather than decrease, hospital emergency room use. Work by Anderson, Dobkin, and Gross (2012) showed that as children “age out” of their parents’ coverage upon turning 19, they tend to use less emergency room care, not more. The difference in these results may be driven by two factors. First, it could be that young adults respond differently to insurance coverage than a typical uninsured person. The evidence from Massachusetts captures the average effect of the reform among all who gained insurance, a broad group of uninsured residents. Second, the Uncompensated Care Pool policies that were in place in Massachusetts may have encouraged low-income residents to use emergency room care more before the reform, resulting in a greater reduction in ER use than would be observed in a state with less generous policies. The applicability of the Massachusetts experience to other states may therefore depend on how similar policies governing the provision of hospital care to the uninsured are across states.

link

Tlaloc on June 9, 2014 at 5:31 PM

This is just the opposite of what Obama promised, so it looks like he lied again.

bw222 on June 9, 2014 at 4:01 PM

Or we could wait a couple years to see how it actually turns out. If it goes like MA the emergency room rise is just a blip that will then recede as patients get used to actually having insurance and start seeing the benefits of preventative care.

Tlaloc on June 9, 2014 at 5:34 PM

this outcome was predicted by ObamaCare critics, but dismissed by the media and Democrats

Of course it was predicted. BASED ON COMMON SENSE.

Something that is missing from most liberals, simply because THEY KNOW EVERYTHING.

GarandFan on June 9, 2014 at 5:35 PM

This is just the opposite of what Obama promised, so it looks like he lied again.
 
bw222 on June 9, 2014 at 4:01 PM

 
Or we could wait a couple years to see how it actually turns out. If it goes like MA the emergency room rise is just a blip that will then recede as patients get used to actually having insurance and start seeing the benefits of preventative care.
 
Tlaloc on June 9, 2014 at 5:34 PM

 
It’s neat how that we-just-need-to-wait-and-see nonsense can be used last year, today, or two years from now.

rogerb on June 9, 2014 at 5:48 PM

Anyone posted this one yet, btw?
 

January 2, 2014
 
Adults who are covered by Medicaid use emergency rooms 40 percent more than those in similar circumstances who do not have health insurance, according to a unique new study, co-authored by an MIT economist, that sheds empirical light on the inner workings of health care in the U.S…
 
“When you cover the uninsured, emergency room use goes up by a large magnitude,” says Amy Finkelstein, the Ford Professor of Economics at MIT and a principal investigator of the study, along with Katherine Baicker, a professor at the Harvard School of Public Health.
 
http://newsoffice.mit.edu/2013/study-having-medicaid-increases-emergency-room-visits

rogerb on June 9, 2014 at 5:59 PM

Tlaloc on June 9, 2014 at 5:31 PM

More recent studies suggest otherwise.

Another:

And another:

And yet, another:

cheeflo on June 9, 2014 at 6:17 PM

Tlaloc on June 9, 2014 at 5:31 PM

More recent studies suggest otherwise.

Another:

And another:

And yet, another:

cheeflo on June 9, 2014 at 6:25 PM

Vader says:
http://www.youtube.com/watch?v=rqhwiXPQ2Dk

Count to 10 on June 9, 2014 at 6:50 PM

What happens when one amplifies demand and discourages supply? In this case, a lot of people discover that their only option is the emergency room. And since they have their own coverage, they flock to the ERs rather than access a clinic with their own resources, and are much more likely to seek access.

Put it this way: What happens when you have an insurance plan, and no doctors around will take it?

Answer: You go to the ER, where EMTALA requires hospitals to provide emergency care whether you can pay or not.

The web sites are far from the only thing incompetently designed for Obamacare.

There Goes the Neighborhood on June 10, 2014 at 12:16 AM