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Medicaid Expansion Didn't Alter Overall ER Use, Study Finds

By Marissa Evans, CQ Roll Call

August 8, 2016—The health care overhaul's Medicaid expansion didn't significantly alter the overall use of hospital emergency rooms, according to a new Health Affairs study that suggests newly insured individuals don't visit ERs more frequently.

The study released Monday found that from 2012 through 2014, overall emergency department use differed by less than 1 percent between states that expanded their Medicaid programs and those that opted out. Some 17 million people gaining coverage through private insurance and expanded Medicaid, the joint health insurance for the poor and disabled.

"Our finding of a lack of an effect of Medicaid expansion on total emergency department visits suggests that emergency department use for the newly Medicaid insured was not substantially different for previously uninsured individuals," the authors wrote.

Under the 2010 federal health care law states can expand Medicaid eligibility to individuals with incomes up to 138 percent of the poverty level. By 2020, states will have to cover 10 percent of the cost of the expansion. Thirty-one states and the District of Columbia have currently taken up the offer. The Health Affairs study looked at the 19 states that expanded as of the beginning of 2014.

Researchers used monthly emergency department data from 478 hospitals. The authors noted some limitations, including that the number of hospitals assessed only represented about 10 percent of ERs nationwide. They also were not capable of distinguishing which patients had new insurance. And they were unable to track the long-term effects of expansion.

Emergency rooms in expansion states saw a 25.5 percent increase in Medicaid beneficiaries between 2012 and 2014 while non-expansion states saw a 1.7 percent increase. Among private insurance policy holders, researchers found a 1.3 decrease in emergency room use in expansion states while non-expansion states saw a 7.1 percent increase. Between expansion and non-expansion states there was a 6.7 percent overall decrease in visits paid by private insurance. Researchers said that may have been attributable to some policyholders becoming Medicaid-eligible under expansion and moving into the program.

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