Emergency room visits hit all-time high during ACA implementation
Patient emergency room visits rose to a record high of 141.4 million in 2014, the same year the Affordable Care Act's insurance expansion went into effect, according to new data from the Centers for Disease Control and Prevention.
The results contradict policy experts' assertions that unnecessary ER use would decline as more people gained access to health insurance under the ACA. The hope was that newly insured individuals would rely less on the ER because they could seek out preventive services and primary care, but the CDC data suggests that hadn't occurred yet in 2014.
For the first time, Medicaid and CHIP beneficiaries accounted for the bulk of ER visits at 34.9%. This aligns with the Medicaid coverage gains that began in 2014 and insured about 14.5 million people. Trailing behind at 34.6% were privately insured individuals and Medicare beneficiaries at 17.5%. Only 11.8% of ER visits were attributed to uninsured individuals.
Considering Medicaid patients only used the ER slightly more than the privately insured shows they both use the ER in the same ways, said Hannah Katch, a senior policy analyst at the Center on Budget and Policy Priorities.
"The CDC data shows there aren't wild disparities between people who have Medicaid versus private insurance," she said.
Similar to previous analyses of ER use, the top reasons for visits were chest and stomach pain, shortness of breath and injuries. Only 4.3% of ER visits were because of non-urgent medical symptoms.
People with chronic conditions also made up a significant portion of ED visits. About 21% of patients had hypertension while 9.8% had diabetes.
Analysts say ER use may still be high because it could take time for the newly insured to become familiar with the care process and seek treatment before they are sick rather than visit an ER.
Katch said that newly insured Medicaid beneficiaries might need more resources to coordinate their care. Several states including Oregon and Missouri have implemented coordinated care initiatives as part of their Medicaid programs to help address social determinants of health.
Medicaid patients also struggle to gain access to a primary care doctor. Some providers refuse to see Medicaid patients because the payment is so low. This has been the experience for some patients in California.
A rising number of patients also visit the ER with mental health issues, said Dr. James Augustine, a board member of the American College of Emergency Physicians and a practicing emergency physician in Cincinnati, Ohio. Mental health services in rural and urban communities are notoriously strapped on resources, often forcing patients who are mentally ill to go to the ER for care.
An aging population with more chronic conditions as well as the opioid epidemic may also be contributing to higher ED visits, Augustine said.
The 141.4 million ER visits in 2014 represent a 10 million increase from 2013. The American College of Emergency Physicians expects the number of ER visits will exceed 150 million in 2016.
A silver lining is that wait times have slightly improved. About 32% of ER patients waited less than 15 minutes to see a doctor versus in 2013 when only 29.8% of patients were seen that quickly.
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