Last year, healthcare reform supporters reeled after the media gave widespread attention to a study of a 2008 Medicaid expansion in Oregon showing it had increased emergency room use by low-income adults. “A stop sign in front of Obamacare's Medicaid expansion,” one paper headlined its report. The uproar continued last January when the full study appeared in the journal Science.
This week, the Medicaid and CHIP Payment and Access Commission released its official pushback document (PDF). It seeks to separate fact from fiction by explaining how and why low-income Medicaid beneficiaries seek care in emergency departments.
“Because of the kind of conversations going on, we decided to look at what the experts have to say on this,” said Anne Schwartz, executive director of MACPAC.
The analysis covers topics such as whether Medicaid beneficiaries are going to the ER more than ever before, intentionally going to ERs for non-urgent care needs, and whether it's truly the case enrollees can't find primary-care doctors. The research is based on literature reviews of dozens of studies and research papers.
Its key findings:
- Most ED use among Medicaid enrollees is necessary.
- Most Medicaid beneficiaries have a primary-care doctor or a usual place for care, so aren't using the ED as an alternative provider.
- There's no evidence to suggest expanding Medicaid will result in increased ED use. Some states that have expanded the program saw no increase in ED utilization, while in others the uptick was short-lived.
“If people believe these myths, it may lead to a policy that limits access to emergency care,” said Dr. Robert O'Connor, vice president of the American College of Emergency Physicians. “Already, you hear about states attempting to cap the amount of ER visits that they'll reimburse for at some arbitrary number.”