Findings in 25-state study challenge the notion that the expansion of health insurance coverage under the Affordable Care Act would reduce emergency department visits, but that’s not necessarily bad.
States that expanded Medicaid coverage under the Affordable Care Act saw 2.5 emergency department visits more per 1,000 people after 2014, while the share of ED visits by the uninsured decreased by 5.3%, according to a study this week in Annals of Emergency Medicine.
“Medicaid expansion had a larger impact on the healthcare system in places where more people were expected to gain coverage,” study lead author Sayeh Nikpay, PhD, of Vanderbilt University, said in remarks accompanying the study. “The change in total visits was twice as large in a state like Kentucky, where most childless adults were ineligible for Medicaid at any income level before 2014, as in states like Hawaii, where childless adults were already eligible for Medicaid above the poverty line.”
Nikpay analyzed patient visits in 14 states that expanded Medicaid coverage and 11 that did not and found that the share of visits covered by private insurance remained constant for expansion states and increased by several percentage points for non-expansion states. Gains in insurance coverage in non-expansion states were almost entirely in the form of private coverage, not Medicaid.
Increases in ED visits were largest for injury-related visits. There was also a large change in payer mix for dental visits, because dental ED visits are most prevalent among low-income, non-elderly adults on Medicaid. Out-of-pocket dental costs were reported as one of the more unaffordable types of care among the target population for Medicaid expansion under the ACA.
John Commins is a senior editor at HealthLeaders.