Medicaid Raises Emergency Room Visits by 40% Compared to the Uninsured

New Findings Contradict Major Arguments from Medicaid Expansion Supporters

MacIver News Service | January 6, 2014

[Madison, Wisc…] A common argument to expand Medicaid nationwide was squashed late last week when newly released data found that people on Medicaid actually go to the emergency room more often than those without insurance.

The results were released by Amy Finkelstein, Ph.D., and Katherine Baicker, Ph.D., the principal investigators of The Oregon Health Insurance Experiment. Finkelstein is the Ford Professor of Economics at the Massachusetts Institute of Technology and Baicker is a Professor of Health Economics at the Harvard School for Public Health.

The Oregon study is one of the first experiments that can accurately measure the outcomes of health insurance and Medicaid with the use of a control group. According to the website, the study, “uses a randomized controlled design – the gold standard for medical evidence – to evaluate the effects of insurance.”

This was all possible because Oregon expanded Medicaid by the use of a lottery system in 2008, which created the perfect opportunity to study the outcomes.

The information released last Thursday said individuals on Medicaid were 20 percent more likely to use the emergency department. Actual visits were measured over an 18-month period and Medicaid enrollees visited the emergency room 40 percent more than the uninsured.

The study found that individuals on Medicaid were more likely to go to the emergency room for cases that did not require a hospital stay, what they deem “outpatient emergency department visits.” Medicaid enrollees were also more likely to visit the emergency room with cases that were classified as, “non-emergent,” “primary care treatable,” and “emergent, preventable.”

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This group of individuals on Medicaid is more likely to go to the emergency department because they know the bill will be paid for. Previously, when uninsured, these individuals would have stayed home until they truly felt it was necessary to get medical care. Instead of changing their behavior once they were covered by Medicaid to use a primary care doctor for non-emergency cases, many still just go to the emergency room because they know they will be admitted and the bill will be paid.

Results released previously revealed that Medicaid did not improve health outcomes, as well. Individuals reported they were healthier, but clinical tests showed no statistically significant effect on blood pressure, cholesterol, diabetes blood sugar control, or diagnosis of or medication for blood pressure or cholesterol.

The only health outcome that saw a significant change was levels of depression. Medicaid reduced observed rates of depression by 30 percent, according to the study. However, there was no statistical increase in the use of medication for depression.

This study refutes the claims of many that support the Affordable Care Act and the expansion of Medicaid. A common argument to expand Medicaid is that individuals would no longer have to rely on uncompensated care at the emergency room. The Oregon experiment shows that they are more likely to rely on the emergency room and there is no statistical change in health outcomes.

Supporters may have to ask themselves if expanding a $415 billion a year program that doesn’t improve health is really the best decision.