The report also found that emergency room reimbursement would have been 39% higher per visit for uninsured patients who are likely to get coverage from private insurers through the new insurance exchanges.
“Historically, emergency departments have carried the bulk of the economic burden for uncompensated care in the healthcare system, which has led to hundred of them closing,” said study lead author Dr. Jessica Galarraga, a resident at George Washington University's School of Medicine and Health Sciences, in a written release. “Over the next few years, that picture could change substantially.”
Under the law, all adults making up to 138% of the federal poverty level are eligible to receive Medicaid coverage. Currently, 25 states and the District of Columbia have opted to expand Medicaid coverage under ACA.
Studies have shown Medicaid beneficiaries tend to use emergency room services more often than those with private health insurance. A research letter published in the Sept. 18 issue of the Journal of the American Medical Association found adults with Medicaid coverage in California were visiting emergency departments in that state at a higher rate than the uninsured and those with private insurance.
One reason for this is that low-income populations, many of whom are eligible for Medicaid coverage, are more likely to suffer from more chronic conditions than other socioeconomic groups.
Study co-author Dr. Jesse Pines acknowledged there are still unanswered questions about the financial impact the Affordable Care Act will have on emergency departments. For example, it's unclear how the new coverage will play out for emergency departments under value-based payment models.
“We were able to show that the per-visit reimbursement in a fee-for-service model will probably go up,” Pines said. “It still remains to be seen what's going to happen with those other issues (payment models).”
Between 1990 and 2009, the number of emergency department in urban areas declined by 27% as the rate of emergency-room visit increased, according to a 2011 study published in JAMA.
“I think the overall impact (of the ACA) on emergency care is really yet to be determined,” Pines said. “I think it will be determined by the success of the Affordable Care Act on impacting care models outside of the emergency department and how much efficiency can be gained by changing care delivery.”
