How does expanding Medicaid affect ER use?

11949965761170200511kcmdrkonqi.svg.medMaine legislators came close to expanding MaineCare but didn’t have quite enough votes to overcome a LePage veto.

Now the Maine GOP, which opposes an expansion on multiple grounds, is claiming that an expansion would lead to newly covered individuals using the hospital Emergency Room for their health care too much.

Notice they don’t argue that against the very clear evidence that an expansion would save lives, improve health and reduce medical bankruptcies.

Nor do they show concern for people who can’t afford needed prescriptions and whose health suffers as a result.

In making this argument, they point to a new study showing increased ER use in Oregon. And while this is certainly a credible study, the Maine GOP analysis only tells part of the picture.

Expanding coverage reduces ER use but not always right away

When people haven’t had coverage, they try to get it, wherever they can. And people who are used to using the ER, do so.

But ER use then falls to lower levels than before coverage was increased. Even this ping-pong can be avoided if the health care system is structured the right way.

A 2012 study examining the effect of insurance on emergency room visits in Massachusetts found that while visits increased immediately after the state enacted universal coverage, reform ultimately “reduced ER usage by between 5 and 8 percent, nearly all of which is accounted for by a reduction in non-urgent visits that could be treated in alternative settings.”

The same thing is happening in Oregon, which received a Medicaid waiver in 2012 to begin “treating thousands of patients through provider networks called coordinated-care organizations.” The state began focusing on using prevention and coordination of health care issues to reduce overall costs, encouraging people who turn up in the emergency room to “get their health care from regular doctors instead.” Early data shows that the experiment has been a success: Emergency room visits by people served by CCOs decreased by 9 percent from 2011 and emergency room spending is down 18 percent from 2011. What’s more, CCOs “reduced hospital admissions for congestive heart failure by 29 percent, chronic obstructive pulmonary disease by 28 percent and adult asthma by 14 percent.” [source]

When care was delivered through Oregon’s coordinated care networks, ER use declined.

And all over the country, delivery system reforms under the Affordable Care Act are saving money and improving care. The Accountable Care Organizations, in Maine and elsewhere, are keeping people healthier, while keeping costs down, in part by reducing ER visits.

In early December 2013, Sen. Angus King “met with representatives from Maine’s largest family of not-for-profit health care providers, MaineHealth, to discuss the marked success of the group’s Accountable Care Organization (ACO). ACOs, which are incentivized under the ACA through several programs including the Medicare Shared Savings Program, attempt to facilitate coordination and cooperation among health care providers in order to improve the quality of care and reduce unnecessary costs. Specifically, ACO arrangements provide financial incentives for providers to improve quality and reduce costs by providing the payment reform necessary to invest in improved value of care for patients.”

As Sen. King said afterward, “These ACA-supported developments will go a long way in helping Mainers to not only live healthier lives, but to also save more money in the long-run.”

Supporting community clinics also helps people and reduces health care costs.

Expanding MaineCare helps Mainers and, especially when done right, reduces ER use.

And greater health coverage producers a healthier population, which can thrive in many ways, including better enabling people to work and support themselves. Those people contribute to our community, by paying taxes and otherwise, and their lives and health should be what health policy is about. Democrats and Republicans should work together to improve the health care delivery system so that costs are controlled and people benefit.

Amy Fried

About Amy Fried

Amy Fried loves Maine's sense of community and the wonderful mix of culture and outdoor recreation. She loves politics in three ways: as an analytical political scientist, a devoted political junkie and a citizen who believes politics matters for people's lives. Fried is Professor of Political Science at the University of Maine. Her views do not reflect those of her employer or any group to which she belongs.