Will fewer people rely on emergency rooms for health care under Obamacare? - DEBATED
Barack H. Obama, JD, 44th President of the United States stated the following in his Aug. 6, 2012 “Presidential Proclamation – National Health Center Week,” available at www.whitehouse.gov:
"Health centers play a key role in bringing vital health care services to 20 million Americans from all walks of life. They lift up rural and urban neighborhoods alike, extending community based, patient directed care to those who need it most. Through their work, health centers strengthen our health care system by helping reduce emergency room visits and easing health care burdens for families across America.
My Administration is working to empower health centers with the resources they need to provide comprehensive, high quality care for more individuals. Thanks primarily to the Affordable Care Act and the American Recovery and Reinvestment Act, health centers are serving nearly 3 million additional patients.”
Gail Lenehan, EdD, MSN, RN, President of the Emergency Nurses Association, wrote in a June 28, 2012 press release “ENA Applauds Supreme Court Decision,” available at www.ena.org:
"Though people will continue to require emergency care, this decision means that millions of people will have access to basic, primary health care and preventive services which should ultimately reduce the numbers of patients seeking routine care in the emergency department. Patients will get the care they need earlier instead of becoming seriously ill and requiring complex, acute care in a hospital emergency department.”
Michael Murphy, CEO of Sharp Healthcare, stated the following during a Mar. 23, 2010 interview on KPBS radio "How Will Health Reforms Affect Community Clinics, Hospitals?," available at www.kpbs.org:
"I think clearly one of the goals of healthcare reform is to get people covered and, clearly, this bill anticipates we'll have 32 million people covered. 16 million of them will be covered by MediCal, 16 million more through the insurance exchange. And the total desire and appropriate thing to happen in this healthcare reform is for those people to get attached to medical home models so that their issues do not become emergency room issues and are treated in the most appropriate and cost effective setting in either community clinics or physicians' offices or ambulatory sites long before they need an emergency room. And, clearly, that should have a positive impact on the emergency room."
Cathy J. Bradley, PhD, Cabell Professor in Cancer Research and Chair of the Department of Healthcare Policy and Research at the School of Medicine, Virginia Commonwealth University, Sabina O. Gandhi, PhD, Assistant Professor in the Department of Healthcare Policy and Research, Virginia Commonwealth University, and David Neumark, PhD, Professor of Economics, University of California at Irvine, et al., stated the following in their Feb. 2012 study "Lessons For Coverage Expansion: A Virginia Primary Care Program for the Uninsured Reduced Utilization and Cut Costs," available at www.content.healthaffairs.org:
"The Affordable Care Act will expand health insurance coverage for an estimated thirty-two million uninsured Americans. Increased access to care is intended to reduce the unnecessary use of services such as emergency department visits and to achieve substantial cost savings.
However, there is little evidence for such claims. To determine how the uninsured might respond once coverage becomes available, we studied uninsured low-income adults enrolled in a community-based primary care program at Virginia Commonwealth University Medical Center. For people continuously enrolled in the program, emergency department visits and inpatient admissions declined, while primary care visits increased during the study period. Inpatient costs fell each year for this group.
Over three years of enrollment, average total costs per year per enrollee fell from $8,899 to $4,569—a savings of almost 50 percent. We conclude that previously uninsured people may have fewer emergency department visits and lower costs after receiving coverage but that it may take several years of coverage for substantive health care savings to occur."
Angel Glover Blackwell, Founder and CEO of PolicyLink, wrote in her June 28, 2012 statement "Victory for Equity! Supreme Court Upholds Affordable Care Act," available at www.equityblog.org:
"The law also focuses on prevention, encouraging not only sick people but also healthy individuals to sign up for coverage. Because of the Affordable Care Act, we can expect fewer emergency room visits for chronic illnesses, and lower costs for preventable and manageable conditions like diabetes, obesity, and asthma.”
Avik Roy, Senior Fellow at the Manhattan Institute, stated in his Feb. 2, 2011 article "Myths of the 'Free Rider' Health Care Problem," available at www.forbes.com:
"EMTALA [the Emergency Medical Treatment and Active Labor Act] requires that hospitals provide emergency care to anyone who needs it, regardless of citizenship, legal status (i.e. illegal immigrants), or ability to pay...
The problem of uncompensated care is one of uncompensated care in the emergency room (and any other care arising from an admission to the ER). But Obamacare's individual mandate doesn't allow people to buy inexpensive insurance focused on emergency care: instead, it forces people to buy comprehensive insurance packages with a generous list of basic benefits, benefits far exceeding those required to address the issue of uncompensated emergency room care...
It's pretty simple: if your health care is paid for, you are more likely to see the doctor more, and consume more tests and procedures, than if you are uninsured. Hence, people with insurance consume, on average, twice as much health care as do the uninsured.
This problem leads to more ER crowding, poorer access to emergency care for the truly vulnerable, and more losses for hospitals...
...[T]he individual mandate is only capable of partially relieving the free-rider [uncompensated care] problem, and simultaneously creates entirely new problems of increased spending, ER overcrowding and limited ER access for the truly needy."
John C. Goodman, PhD, President and CEO at the National Center for Policy Analysis (NCPA), stated in his June 18, 2010 article "Emergency Room Visits Likely to Increase Under ObamaCare," published by NCPA on its website, www.ncpa.org:
"More people are likely to turn to the emergency room for their health care and they are likely to do so more frequently under the new health reform legislation. This finding is surprising because an oft repeated argument for insuring the uninsured is that it will allow people to seek less costly and more accessible care elsewhere.
We find that emergency room costs will increase for two reasons: 1) about half the newly insured will enroll in Medicaid and Medicaid patients seek emergency room care more often than the uninsured, and 2) while the newly insured will try to increase their consumption of care, the absence of any program to create more providers will force patients to turn to emergency rooms as the outlet for increased demand."
Lynn Massingale, MD, Executive Chairman of TeamHealth, was quoted as stating the following in the June 14, 2012 article "2 Major Implications of the PPACA Ruling for Emergency Departments," available at www.beckerhospitalreview.com:
"The mere fact that more individuals will be covered by insurance will bring more patients to the ED [Emergency Department], especially since the uninsured population has healthcare needs on reserve. In addition, there is not a primary care practice excess in the country. The odds are that newly insured individuals will not be able to see primary care practitioners and instead will visit an emergency room...
ED patient volumes are historically increasing, particularly as hospitals close and patients are consolidated into fewer ERs. The law and any additional coverage for individuals will only add to the factors of aging population, lack of primary care capacity and the closing of hospitals. These factors all work together to increase patient volume."
Douglas Holtz-Eakin, PhD, President of Operation Healthcare Choice at the American Action Forum, and Michael Ramlet, Coordinator of Operation Healthcare Choice at the American Action Forum, stated the following in their Sep. 2010 report "Healthcare Reform and Medicaid: Patient Access, Emergency Department Use, and Financial Implications for States and Hospitals," available at www.americanactionforum.org:
"…[Obamacare is] likely to dramatically expand the use of emergency room care, as Medicaid's low reimbursement rates limit bene?ciaries' access to primary care physicians... We estimate that the emergency department impacts alone will generate 68 million visits and add $36 billion to the nation's healthcare bill...
The Obama Administration's decision to push insurance coverage through a major expansion of Medicaid ensures a greater number of emergency room visits...
Beginning in 2014 with the mandated expansion of Medicaid eligibility, the historical rates of emergency department utilization indicate that policymakers should expect a substantial increase in annual emergency room visits...
By 2019, the increased overutilization of the America's emergency departments stemming from the Obama reform will increase national healthcare expenditures by $35.8 billion compared to prior law."