ER use skyrocketing with Obamacare?

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.”

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