Are Fewer People Relying on Emergency Rooms for Health Care Under Obamacare? – DEBATED
General Reference (not clearly pro or con)
Soumya Karlamangla and Ryan Menezes, Los Angeles Times staff reporters, stated in their Jan. 1, 2015 Los Angeles Times article titled “Since Obamacare, L.A. County ER Visits Show Hospitals in ‘State of Flux'”:
“President Obama has promised his signature health law will gradually reduce expensive ER visits as access to other kinds of care is expanded. Critics contend newly insured patients — especially those enrolled in Medi-Cal, the state’s low-income health program that picks up most patient costs — aren’t likely to seek care elsewhere, and will overwhelm emergency rooms.
Neither of those outcomes were clearly evident in the first months of the new healthcare system’s operation in Los Angeles County, according to a Los Angeles Times analysis.
Data hospitals report to the state show that as insurance coverage was extended to hundreds of thousands of residents, ER visits for ailments not serious enough to require an admission grew 3.9% in the county in the first half of 2014, compared with the same period the previous year. The growth is in line with annual increases of 3% to 5% in the three years prior to the federal healthcare overhaul.
Despite little rise in overall emergency room use, the analysis found some significant changes in the distribution of those outpatient ER visits.
The county’s three large public hospitals, which historically have cared for many uninsured patients, recorded a 9% drop in such cases. At the same time, several private hospitals reported double-digit percentage increases in outpatient visits, the analysis found.
What the uneven and changing usage patterns mean — and whether they signal the beginning of a long-term rearrangement of how patients will seek treatment — is not yet clear.”
Tina Hernandez-Boussard, PhD, Assistant Professor of Surgery and Biomedical Informatics at Stanford University, et al., stated in their Sep. 2014 study titled “The Affordable Care Act Reduces Emergency Department Use by Young Adults: Evidence from Three States,” published in Health Affairs:
“The Affordable Care Act (ACA) extended eligibility for health insurance for young adults ages 19–25. This extension may have affected how young adults use emergency department (ED) care and other health services. To test the impact of the ACA on how young adults used ED services, we used 2009–11 state administrative records from California, Florida, and New York to compare changes in ED use in young adults ages 19–25 before and after the ACA provision was implemented with changes in the same period for people ages 26–31 (the control group). Following implementation of the ACA provision, the younger group had a decrease of 2.7 ED visits per 1,000 people compared to the older group—a relative change of -2.1 percent. The largest relative decreases were found in women (-3.0 percent) and blacks (-3.4 percent). This relative decrease in ED use implies a total reduction of more than 60,000 visits from young adults ages 19–25 across the three states in 2011. When we compared the probability of ever using the ED before and after implementation of the ACA provision, we found a minimal decrease (-0.4 percent) among the younger group compared to the older group. This suggests that the change in the number of visits was driven by fewer visits among ED users, not by changes in the number of people who ever visited the ED.”
PRO (yes)
Pro
The Emergency Nurses Association (ENA) stated in a June 28, 2012 press release written by then-ENA President Gail Lenehan, EdD, MSN, titled “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.”
Pro
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 the Equity Blog website:
“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.”
Pro
Barack Obama, JD, 44th President of the United States stated the following in his Aug. 6, 2012 “Presidential Proclamation – National Health Center Week,” available at the White House website:
“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.”
CON (no)
Con
The American College of Emergency Physicians (ACEP), in its Mar. 2015 report prepared by Marketing General Incorporated, titled “2015 ACEP Poll Affordable Care Act Research Results,” available at the ACEP website, stated:
“Since the implementation of the ACA, the majority of member physicians have noticed an increase in the volume of emergency patients. Specifically, 47% of emergency physicians indicate slight increases in the number of patients, while 28% of respondents report significant increases in the number of emergency patients.”
Con
Avik Roy, MD, Forbes‘ Opinion Editor and Senior Fellow at the Manhattan Institute, stated in his Feb. 2, 2011 article “Myths of the ‘Free Rider’ Health Care Problem,” available at the Forbes website:
“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.”
Con
The National Center for Policy Analysis (NCPA) stated in a June 18, 2010 article written by then-NCPA President and CEO John C. Goodman, PhD, titled “Emergency Room Visits Likely to Increase Under ObamaCare,” published by NCPA on its website, 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…
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.”
Con
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 the Becker’s Hospital Review website:
“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.”
