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ACA-Related Medicaid Expansion Slightly Increased ED Visits

One of the benefits touted for expanding Medicaid eligibility under the Affordable Care Act (ACA) was a reduction in pricey emergency department visits. But did that really occur?

An article in The Annals of Emergency Medicine explores the answer to that question after previous research provided mixed results. Researchers at Vanderbilt University sought to determine if Medicaid expansion under the ACA changed the number of ED visits or the payer mix.

This study team employed data from the Agency for Healthcare Research and Quality’s Fast Stats program, comparing changes in ED visits per capita and the share of ED visits by payer — Medicaid, uninsured, and private insurance — in 14 states that expanded Medicaid in 2014 vs. 11 states that did not. The investigation controlled for state-level demographic and economic characteristics.

Results indicated that total ED use per 1,000 population increased by 2.5 visits more in Medicaid expansion states than in non-expansion states after 2014. ED visit increases were greatest for patients with injuries and for states with the largest changes in Medicaid enrollment, based on what researchers said could be measured.

At the same time, compared with non-expansion states, the share of ED visits covered by Medicaid increased 8.8% while the uninsured share dropped by 5.3% in expansion states.

Changes in payer mix have resulted from the ACA’s Medicaid expansion, researchers conclude. The study also found that the expansion increased ED use.

Previous research on the topic has been inconclusive, the researchers say. Although evidence from hospital discharge data indicated no increase in inpatient discharges in states that had expanded Medicaid compared with those that had not, evidence from population-based surveys suggested that inpatient visits had increased.

In addition, the article notes, some early evidence from selected hospitals and states found no ED visit increases, which the authors found surprising.

Some analysts expected ED visits to increase substantially among patients with new Medicaid eligibility. A 2015 poll by the American College of Emergency Physicians found that 75% of emergency physicians reported an increase in patient volume between January 2014 and March 2015, and 56% reported an increase in Medicaid volume specifically.

Study authors called for future research to investigate the longer-term effects of Medicaid expansion and whether the expansion led to changes in acuity of visits.

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