“The key finding is that the newly enrolled, who had not had any care in the previous year, had very high hospital and ER use early on, but that diminished rapidly,” said study-co-author Gerald Kominski, director of the UCLA Center for Health Policy Research.
The authors said their report offers new evidence in the debate over whether the ACA's Medicaid expansion authorized by the Patient Protection and Affordable Care Act will lead to a long-term increase in ED utilization. A study published in the journal Science in January found that Oregon's 2008 limited expansion of Medicaid led to a 40% initial increase in emergency department use at Portland-area hospitals.
Medicaid expansion supporters have argued that expanding coverage will reduce ED use and enable patients to receive care from regular primary care providers. But ACA critics said the study showed that Medicaid expansion will increase costs.
“Those findings have been cited as justification for states not to expand their Medicaid programs,” the UCLA authors wrote. “Whether increased utilization following Medicaid expansion will be temporary or permanent cannot be answered by the Oregon experiment, however, because no measures were implemented to manage utilization, and the study was limited in both duration and geographic implementation.”
Sarah Taubman, the lead researcher on the Oregon study, declined to comment on the UCLA study, saying she hadn't had time to study it.
Dr. Mark Reiter, president at American Academy of Emergency Medicine, said one study is not enough to decide the question of whether Medicaid expansion will increase or decrease ED utilization. “It's encouraging that it shows a decrease in utilization, but I think it's too early to draw many conclusions from it,” he said.
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