Kokomo Tribune; Kokomo, Indiana

February 11, 2014

Feb. 11, 2014: Letters to the editor

Kokomo Tribune

---- — ACA could up visitsto emergency rooms

Supporters of President Barack Obama’s health care law had predicted that expanding insurance coverage for the poor would reduce costly emergency room visits, as people sought care from primary doctors.

But a new study conducted in the state of Georgia has flipped that assumption on its head, finding the newly insured actually went to the emergency room more often.

The study, published in the journal Science, compared thousands of low-income people in the Georgia area who were randomly in a 2011 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. The pattern was so strong that it held true across demographic groups, times of day and types of visits, including treatment for concerns that could have been handled in primary care settings.

The finding casts doubt on the hope that expanded insurance coverage will help rein in rising emergency room costs, just as more than 2 million people are gaining coverage under the Affordable Care Act.

Instead, the study suggests the surge in the numbers of insured people may even greater pressure emergency rooms and increase costs. Nearly 30 million uninsured Americans could gain coverage under the law. About half of them through Medicaid. The first policies took effect Wednesday.

I suspect that the finding will be surprising to many in the political debate. Economists who worked on the study said the increased use of emergency rooms was driven by a basic economic principle. When things or services get cheaper, people buy and use more of them.

Medicaid coverage also reduces the costs of going to a primary doctor, and a previous analysis of data from the Georgian experiment found that doctor visits also increased substantially.

Researchers concluded that gaining health coverage led to an across-the-board rise in the use of health care.

How to use a plan and when to seek emergency care involves a learning curve that doesn’t happen overnight, said a health researcher at George Washington University who was not involved in the study.

Col. Bill Smyser