By Kathryn Watson | Watchdog.org, Virginia Bureau
ALEXANDRIA — Increase Medicaid patients to decrease emergency room visits — it’s one of the top arguments made by those advocating expansion in the Old Dominion.
“When patients get sick, they seek care in our emergency rooms, where costs are the most expensive,” wrote Dr. Jennifer Smith, a physician with Bon Secours Richmond Health System in public comments submitted online to Virginia’s Medicaid Innovation and Reform Commission. “With Medicaid expansion, over 300,000 additional Virginians could see a doctor in a timely manner, protecting their own health and avoiding inefficient use of medical resources.”
It’s a common, reoccurring comment that — on its face — makes sense, but it may not be the case. As MIRC decides whether to expand the program by up to 400,000 Virginians, it’s worth evaluating.
A handful of studies published in medical journals contradict the much-cited claim in Virginia that expanding Medicaid will keep state and private insurance costs down by keeping more people out of emergency rooms.
When Oregon drew 30,000 random names from a waiting list and placed them on Medicaid, researchers “did not find significant changes in visits to the emergency department or hospital admissions” after two years, according a study published by the New England Journal of Medicine.
A study published in the Journal of the American Medical Association found that adult Medicaid patients were three times more likely than the uninsured, and seven times more likely than the privately insured, to use an emergency room for conditions that could have been taken care of with primary care.
The Annals of Emergency Medicine reported that Medicaid patients are about 1.51 times as likely as privately insured, and 1.42 times as likely as the uninsured, to have at least one emergency room visit a year.
“The data seems to at least show that it’s not going to be some drastic reduction in unnecessary ER use,” Jonathan Ingram, a director of research for the Florida-based Foundation for Government Accountability, told Watchdog.org.
“In fact, (being on Medicaid) actually increases their use of hospital emergency rooms,” Ingram said.
Why? There are a handful of reasons.
Medicaid patients are often sicker than the rest of the population, and sometimes people on Medicaid lack the transportation or education about primary care needed to get them there.
Accessing a primary care doctor is much harder for Medicaid patients, who are often put on back burners by their doctors — if they have one — because Medicaid just doesn’t pay as well as private insurance or even Medicare. Medicaid pays roughly two-thirds what private insurance pays, leading to one in four Virginia doctors no longer accepting new Medicaid patients.
“Medicaid patients tend to visit the ER more, partly because they tend to be in poorer health overall. But they also visit the ER more because they can’t see their primary care provider in a timely fashion or at all,” wrote Dr. Adit Ginde, an MD, MPH, and FACEP at the University of Colorado School of Medicine and senior author of the study published in the Annals of American Medicine.
On top of that, Medicaid patients don’t have to foot the massive ER bills.
“Well Medicaid makes the ER free for people,” said Michael Cannon, director of health policy studies for the Libertarian-leaning Cato Institute. “Nobody spends (other people’s) money as carefully as they do their own.”
So accessibility wins out, he said. Emergency overcrowding isn’t about to go away with Medicaid expansion — in Virginia or anywhere else.
“Why wouldn’t they just go and use the emergency room instead of waiting forever to get into a private doctor?” Cannon said.
— Kathryn Watson is an investigative reporter with Watchdog.org, and can be reached at email@example.com.
- Obamacare compliance means less money for TN service agencies
- The mystery of Obamacare spending in Arkansas
- Obamacare raises questions for MD small business owners
- Kansas official on Obamacare: ‘Let someone else be the guinea pig’
- Obamacare insurance marketplace has plenty of kinks on first day
- OR’s Obamacare insurance marketplace hits technological snag
- Fail: Day 1 of the New Mexico Obamacare rollout
- Senator asks: Do you want this dysfunctional government taking over health care?
- Jobs, coverage at risk with Obamacare, MN union health official says
- Oregon’s Obamacare ads resemble middle school art
- VIDEO: Obamacare vs Affordable Care Act: Comedy triumphs in court of confusion
- Patience is key to navigating Illinois’ Obamacare marketplace
- Hawaii residents, lawmakers frustrated with health connector glitches
- Healthy young, key to Obamacare, aren’t buying it
- NM’s health exchange tries to lure ‘young invincibles’
- Obama drama: Senator blames governor for big rate hikes
- Progressive group navigates Oregon students through Obamacare
- Maddening: Trying to log onto federal health care site
- You know that one guy who successfully signed up for Obamacare? He didn’t
- What’s wrong? It’s been a week, and Obamacare website still not working
- HHS Secretary Sebelius back in FL after embarrassing Obamacare rollout
- Health centers enroll Floridians in Obamacare as application problems persist
- VIDEO: Stewart skewers Sebelius on Obamacare
- Obamacare effect? 9 companies exit Nebraska’s health insurance market
- Obamacare: Children of undocumented parents face an uncertain future
- Which way do we go? Obamacare navigator registration in TN in question
- NM health exchange tries to ease problems with Obamacare website
- CPA says hype over Obamacare small business tax credit is misleading
- Obamacare navigator under fire for arrest warrant
- Reports of Obamacare fraud emerge in Tennessee
- After two weeks, FL online Obamacare enrollees are hard to find
- Illinois state governor touts 100K Obamacare enrollees, all in Medicaid
- Kansas lawmaker calls for crackdown on Obamacare navigators
- WI health care exchange seeing few getting through
- Hawaii’s Obamacare exchange relaunches with more glitches
- We’ll know next month how many people in NM signed up for Obamacare — maybe
- Zero: Number of Nebraskans Obamacare navigators have signed up
- It took this Delaware woman 11 days to sign up for Obamacare – and she was the first
- How many people have signed up for health insurance in VA? Who knows?
- What else? NM federal health exchange ads stalled due to website problems
- Blue Cross hires temp workers to deal with Obamacare glitches
- If Obamacare is the next Medicare, will physicians leave en masse?
- Three problems that won’t be solved by fixing the Obamacare exchange glitches
- Plenty of Oregonians interested in Obamacare, but none can enroll online
- Criticize this: Obamacare premiums a near match to WI disclosures
- Report: Missourians will see sharp rise in premiums under Obamacare
- Kansas navigators say they’ve enrolled no one in Obamacare
- Obamacare too costly for rich Coloradans, Democrat congressman says
- Study: Kansas premiums to spike following Obamacare rollout
- Hang on to your candy: Creepy Uncle Sam is back
- Obamacare or bust: NM Watchdog turned back again
- Medical journals, experts refute claim that Medicaid cuts ER use
- Arkansas spends $4M on Obamacare ads, wants more
- LOL: In July video, HHS bragged about being ‘on schedule’ with Obamacare
- Illinois uses Day of the Dead to market Obamacare
- Sebelius denies GOP’s Terry ‘unreliable’ Obamacare info
- About 290,000 Washington residents lose health insurance plans
- Broken promise: Obamacare cancels almost 20,000 Kansas health care plans
- Top hospitals opt out of Obamacare
- Obamacare moves to intensive care
- Obamacare provision could lead to more Medicaid fraud
- Obamacare: Religious groups want to ‘move mountains’
- Obamacare hitting Wisconsin residents with double whammy
- Kansas AG: Obamacare threatens consumer privacy
- 1,500 in New Mexico have to move out of the high-risk insurance pool
- Cover Oregon website fiasco creates jobs, but costs millions
- For Florida’s Obamacare small business exchange, it’s crunch time
- Only 877 Wisconsinites have signed up for Obamacare, federal report says
- Just 172 in NM have completed Obamacare applications: ‘Woefully inadequate,’ says NMIX board member
- With only 346 Oklahomans signed up, leaders decry ‘Obamacare debacle’
- Defying Obamacare: ‘Send them the bill,’ NM insurance official says
- Kansas Obamacare enrollment dwarfed by nearly 20,000 cancellations
- Numbers don’t lie: In Illinois, Obamacare means Medicaid
- Wisconsin governor proposes insurance plan to address Obamacare rollout failure
- Tennesseans might know Tuesday if they can keep canceled health insurance
- People demand answers over Oregon’s Obamacare fail
- Calif. says ‘no’ to Obamacare freebies, makes own law
- HI health exchange violates federal law, League of Women Voters say
- Obamacare video winner: ‘Forget about the price tag’
- Harvard study finds ‘striking’ rejection of Obamacare by young Americans
- HI health exchange has signed up 574 people, for about $348,000 apiece
- Are the uninsured getting Obamacare coverage in Illinois?
- Secret Obamacare handbook the feds don’t want you to see is online
- Lost in translation: Once-supportive Hispanics turning backs on Obama, ACA
- HI Obamacare exchange not fiscally sustainable, lawmakers told
- Illinois’ latest Obamacare targets: gold diggers and momma’s boys
- Now Democrats are bashing California’s Obamacare exchange, too
- Obamacare: For $1.37M we get Richard Simmons in lurid web stream
- Obamacare: A welcome mat for IRS horrors
- California senator seeks audit of state Obamacare exchange
- Report: Hawaii ranks worst for Obamacare signups
- CA senator sues Obamacare exchange for causing policy cancellations of 1M
- Failure of Maryland Obamacare exchange could mean higher premiums in North Dakota
- Video: Watch Creepy Uncle Sam make it rain
- Five bright spots surrounding the Obamacare exchange failures
- Obamacare architect admitted in 2012 states without exchanges lose subsidies
- Architects of Richard Simmons Obamacare dance-off rehired in $156M PR campaign