Researchers Report on ED Use Post-ACA Implementation

Two recent studies on emergency departments (ED) show two sides to patients’ use of the ED.


Researchers from the Colorado Hospital Association (CHA) reported that Medicaid enrollees added under healthcare reform are both sicker and increasing their use of hospital EDs. The national analysis is based on data from 450 hospitals in 25 states, 13 of which expanded and 12 of which did not.


Health Affairs reported that the healthcare reform provision that allowed young adults to stay on their parents’ insurance plans longer might have slowed the ongoing increase in their use of hospital EDs.


New Medicaid Enrollees and ED Use


Researchers have been reporting that states that expanded Medicaid as authorized by the Affordable Care Act (ACA) have increased their share of Medicaid patients and reduced their share of self-pay patients. Experts have predicted that the new Medicaid enrollees would be healthier than traditionally eligible Medicaid enrollees. The new research from CHA doesn’t match these predictions.


An examination of the relative health of the new Medicaid enrollees was conducted in an in-depth, Colorado-specific portion of the study. The research shows a 10 percent increase in the case mix index (a measure of complexity and resource needs) in the first quarter of 2014 compared to the first quarter of 2013.


ED usage increased 5.6 percent among expansion state hospitals in the second quarter of 2014 compared to a 1.8 percent increase in non-expansion states.

(“New Medicaid Enrollees Sicker, Increasing ED Use,” HFMA Weekly News, September 12, 2014)


Young Adults and ED Use


The Health Affairs study compared ED use by young adults before and after a September 2010 provision of ACA went into effect. This provision allowed people through age 25 to stay on their parents’ insurance. Under this provision, the ongoing increase of these young adults’ use of hospital EDs has slowed.


According to the study’s authors, there was a reduced increase in ED use by this cohort of 2.1 percent, or 99,178 fewer ED visits in the three largest states examined (California, Florida and New York) than would otherwise have occurred.

The authors speculated that the increased insurance coverage could have encouraged better access to healthcare in non-ED settings, such as physician’s offices, which potentially would have reduced the use of ED care by the young adults.


However, the authors “stopped short of saying their findings confirmed a link between the ACA provision and the resulting ED use.” (“Study: ACA Coverage May Have Curbed ED Use Among Young Adults,” HFMA Weekly News, September 12, 2014)




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