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Study: ER Visits Up After Medicaid Expansion

Many people newly insured by Medicaid under the federal health care law are seeking treatment in hospital emergency rooms, one of the most expensive medical settings, a study released Monday concludes.

The analysis by the Colorado Hospital Association provides a real-time glimpse at how the nation’s newest social program is working.

It also found indications that newly insured Medicaid patients admitted to hospitals may be sicker than patients previously covered under the same program, which serves more than 60 million low-income and disabled people.

The findings have implications for federal and state policymakers managing the coverage expansion under President Barack Obama’s health care law. Taxpayers could save millions of dollars if newly insured Medicaid patients with routine needs are steered to community health centers or urgent care clinics, as opposed to service-intensive ERs.

The Affordable Care Act expanded Medicaid to cover many low-income adults with no children living at home. They were previously ineligible in nearly every state. About 7 million people nationally have been added to the rolls of the safety-net program, which is jointly run by the federal government and the states.

More than half the states have signed up for the Medicaid expansion, with Washington paying the entire cost through 2016, and gradually phasing down to a 90-percent share thereafter. Another part of the law, which is available in every state, offers subsidized private health insurance to people who don’t have a health plan on the job.

“When this newly insured population is trying to understand the system, they are using the easiest access point, and that is the ER,” said Chris Tholen, a vice president of the hospital association.

The study looked at data reported by 450 hospitals in 25 states, through the middle of this year. Thirteen of the states expanded Medicaid, and 12 states did not.

In addition, researchers with the association’s Center for Health Care Information and Data Analytics drilled down into reports from Colorado hospitals. That analysis showed that newly insured Medicaid patients appear to be sicker.

Looking at the broad sample of 25 states, the study found that the average number of ER visits in states that expanded Medicaid increased by 5.6 percent, when the second three months of this year were compared with the same period in 2013. That increase was more than three times bigger than experienced by hospitals in states that did not expand. It was also outside the range of normal year-to-year fluctuations, Tholen said.

Examining a different data set from Colorado-only hospitals, the researchers also found a rise in a widely used measurement for the clinical complexity of Medicaid patients.

“They had diseases that weren’t being taken care of,” said Tholen. “We are seeing those needs are now being met. To me, that is the real definition of success.” He added, coverage “is more than just peace of mind for people who needed health care and couldn’t get it.”

The study also found notable declines in hospital charity and self-pay charges for states that expanded Medicaid. But researchers said it will take more time to get a full picture of the impact on hospital finances.