New Study: Expanding Medicaid Drives Up ER Visits

A Harvard University study shows a 40 percent increase in emergency room visits among low-income adults in Oregon who gained Medicaid coverage in 2008 through the state’s expansion program. The study, which followed about 25,000 Medicaid recipients for 18 months after the expansion, was published on last week in the journal Science.
Medicaid is a government program that provides health insurance to low-income families or disabled persons. This week, the Patient Protection and Affordable Care Act went into effect, broadening the eligibility requirements for millions of people who can now sign up through Medicaid.
 Critics of the study argue that the research had taken place under the state’s old model of providing healthcare, Sean Kolmer, deputy chief of policy and programs for the Oregon Health Authority, told the Washington Post.  In fact, much has changed in the five years since the state’s Medicaid expansion, and in the last two years (outside the study’s research scope) ER visits have actually declined.
Without disputing the results, officials claim that patients were going to the ER for primary care visits, and through budget modifications and patient education, they were able to reduce visits. “Most of the things that are being cut are management of chronic conditions,” he says. “It’s things like congestive heart failure and COPD. You shouldn’t see, for example, a kid with asthma going to the ED. That’s completely preventable.”
Some of the changes include limits for each enrolled person, as well as having community heath workers stationed at the emergency departments to divert less priority cases to clinics or primary care physicians. In 2011, the first year of this new model, Oregon saw a 9 percent reduction in ER visits.
Nationwide, Obamacare has allowed states to expand Medicaid to families making 138 percent of the federal poverty level, and observers question whether other states will see fluctuations in the number of patient visits to hospital ERs.
According to one of the writers of the report, Katherine Baicker, an economist at the Harvard School of Public Health, only 21 percent of Medicaid ER visits at the Oregon hospitals were for conditions that could not have been prevented; and 53 percent of visits were for conditions that could have been treated outside the ER or were not emergencies.
She also said that those who had coverage and therefore a reduced financial strain, had better mental health reports – specifically, lower rates of depression – than the uninsured.  Thus, proving that once again there is a real benefit to health insurance, but at a cost.
Michael F. Cannon, contributor to Forbes magazine online, says there is a growing realization that the ACA will come at a higher cost that projected, and that local and federal governments may have to rethink the health care law and its expansion of Medicaid, given the results of this study.
Bloomberg News reports that a projected 19 million people will join Medicaid this year, a 35 percent increase from last year because of the ACA. The Obama administration had originally projected that  $957 billion will be spent on the program by 2021.
S.C. Rhyne is a blogger and novelist in New York City. Follow the author on twitter @ReporterandGirl or on and visit her website at
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