One of the key ways to cut healthcare costs is to reduce emergency-room visits. They’re costlier than primary-care appointments, and patients who clog ERs with preventable issues divert precious resources away from sicker people. The question is, though, what makes people visit the emergency room more: Having health insurance, or lacking it?
A new study complicates the answer to that question and has major repercussions for states debating whether, and how, to expand their Medicaid programs.
Current Status of Medicaid Expansion Decisions
To review: Under the Affordable Care Act, the states were supposed to expand Medicaid, the health insurance program for the poor, to people making up to 133 percent of the poverty level. The Supreme Court ruling on the law made the expansion optional for the states. Only 28 of the states have opted to do the expansion so far. There are some pretty big naysayers, like Virginia and Texas, with huge uninsured populations. One reason those states' leaders give for their decision is that they fear the surge in Medicaid enrollees will drive up healthcare costs and strain medical services.
There's some merit to this argument. A study of an earlier Medicaid expansion in Oregon published in January found that newly enrolled Medicaid patients went to the emergency room 40 percent more than other people did, often for conditions that could easily have been treated by a family doctor.