And not unexpected either, except for those who continue to defend ObamaCare as the solution to rising medical costs. A poll of over 2,000 emergency room doctors shows that visits to ERs have increased, and in precisely the population that ObamaCare advocates claimed they would decrease and reduce costs:
A survey of 2,098 emergency-room doctors conducted in March showed about three-quarters said visits had risen since January 2014. That was a significant uptick from a year earlier, when less than half of doctors surveyed reported an increase. The survey by the American College of Emergency Physicians is scheduled to be published Monday.
Medicaid recipients newly insured under the health law are struggling to get appointments or find doctors who will accept their coverage, and consequently wind up in the ER, ACEP said. Volume might also be increasing due to hospital and emergency-department closures—a long-standing trend.
“There was a grand theory the law would reduce ER visits,” said Dr. Howard Mell, a spokesman for ACEP. “Well, guess what, it hasn’t happened. Visits are going up despite the ACA, and in a lot of cases because of it.”
ObamaCare includes a Medicaid expansion component, which advocates claimed would get people out of ERs and into clinics. Emergency rooms cannot deny service, and many people without health insurance chose to seek care in ERs and then let their bills go unpaid, creating the need for government subsidies. By forcing people into either health insurance plans or Medicaid through the individual mandate, ObamaCare would give these patients the option to seek medical care at lower-cost clinics rather than through expensive ER visits, which was a major theory for its supposed cost controls.
And in theory, that sounded pretty good. In practice? Not so much:
The American College of Emergency Physicians (ACEP), which conducted the survey, pointed to the shortage of primary care doctors and the low payment rates from Medicaid, which accounts for much of ObamaCare’s coverage expansion.
“America has severe primary care physician shortages, and many physicians will not accept Medicaid patients because Medicaid pays so inadequately,” Dr. Michael Gerardi, president of ACEP, said in a statement. “Just because people have health insurance does not mean they have access to timely medical care.”
The inability to get a timely appointment with a primary care doctor leaves people still relying on emergency rooms, he argues.
A somewhat smaller majority of respondents in this poll (56%) say that the increase is coming from Medicaid patients for this reason. Simply forcing people into Medicaid doesn’t solve the problem, because Medicaid’s reimbursements make that business unattractive for family practice clinics. This is the difference between health insurance and health care, which was pointed out repeatedly by ObamaCare critics from the beginning.
The trend is hardly new, either. Fifteen months ago, the New York Times reported that a study in Oregon showed the exact same trend:
Supporters of President Obama’s health care law had predicted that expanding insurance coverage for the poor would reduce costly emergency room visits because people would go to primary care doctors instead. But a rigorous new experiment in Oregon has raised questions about that assumption, finding that newly insured people actually went to the emergency room a good deal more often.
The study, published in the journal Science, compared thousands of low-income people in the Portland area who were randomly selected in a 2008 lottery to get Medicaid coverage with people who entered the lottery but remained uninsured. Those who gained coverage made 40 percent more visits to the emergency room than their uninsured counterparts during their first 18 months with insurance.
The pattern was so strong that it held true across most demographic groups, times of day and types of visits, including those for conditions that were treatable in primary care settings.
The findings cast doubt on the hope that expanded insurance coverage will help rein in emergency room costs just as more than two million people are gaining coverage under the Affordable Care Act. And they go against one of the central arguments of the law’s supporters, that extending insurance to large numbers of Americans would reduce emergency room use, and eventually save money.
That concept is still valid. The problem is in the assumptions about how to structure the reform. ObamaCare took the top-down, one-size-fits-all progressive approach of mandates and government interventions. This is the inevitable outcome — a shrinking of the market, artificial shortages, and the utterly predictable sharp rise in costs and bad outcomes from it.
The proper solution involves leveraging the free market to increase supply, send proper price signals, and put the government out of the health-insurance business. Allow insurance companies to sell across state lines, push them out of the health maintenance business with a reliance on catastrophic coverage and HSAs, and encourage the growth of retail clinics that compete openly and honestly on price. In short, we should adopt the Lasik or plastic surgery model, where providers are bountiful and prices drop as a result of high supply and open competition. ObamaCare took us in exactly the wrong direction, and it will end up sending costs soaring as a result — and it already has begun.