February 19, 2016
Despite theorizing that the Affordable Care Act (ACA) would lower emergency room visits, data from a new government report showed no significant change in use occurred after the first full year of implementation, despite 7.9 million Americans gaining health insurance during that time.
The National Health Statistics Report looked at data from the 2013 and 2014 National Health Interview Survey, which asked people why and how often they went to the emergency room. Proponents of the ACA speculated that when more Americans had insurance, they would opt to go to their doctor’s office as symptoms developed, rather than the emergency room—which typically delivers pricier care—when a crisis occurred.
According to the data, uninsured people still remain more than twice as likely than those with private insurance and Medicaid to go to the emergency room because they lacked access to another provider—something that was also an issue before the ACA and theorized to decrease once insurance was mandated.
The report, however, also found that there are other reasons patients head first to the emergency room other than lack of insurance. While the majority (77%) reported they go because of the seriousness of their condition, a small group (12%) said they went because their doctor’s office wasn’t open. Seven percent of those surveyed went to the emergency room at least once in 2014, and said they did so because they had no other place to go, the hospital was the closest provider, or they were used to getting care there.
Some change did occur between 2013 and 2014. Decreases were seen among patients (aged 18-64) with Medicaid who visited the ER [emergency room] (37.7% in 2013 vs 35.2% in 2014) and uninsured adults with more than one visit (8% in 2013 vs 5.9% in 2014). Patients with Medicaid, according to the report, have more frequent visits because they often have more serious medical needs.
“ER use, whether appropriate or inappropriate, is an expensive source of care,” the authors of the report concluded. “The findings indicate that so far, there have been no changes over time, and disparities between groups persist. Continued monitoring of ER use by insurance coverage status and by demographic subgroups may help identify influential factors that can be addressed to reduce inappropriate ER use and ER use overall.”
The lack of significant changes may be because people with first time coverage are still adjusting to how health insurance works.—Kelsey Moroz
References: Ginid RM, Black LI, Cohen RA. Reasons for emergency room use among U.S. adults aged 18064: National Health Interview Survey, 2013 and 2014. National Health Statistics Reports. Number 90. February 18, 2016.