The lead paragraph in yesterday’s Wall Street Journal article (Emergency-Room Visits Keep Climbing) is typical:
Emergency-room visits continued to climb in the second year of the Affordable Care Act, contradicting the law’s supporters who had predicted a decline in traffic as more people gained access to doctors and other health-care providers.
Some ACA supporters did make that claim. Meanwhile it’s long been evident to many other supporters –including me– that those with insurance tend to use the emergency room and other medical services more than the uninsured.
Interestingly, I’ve never seen an article like this citing opponents of the law who called this issue out ahead of time. That’s because at the time many conservatives were busy blaming the uninsured for clogging up the emergency department! These folks probably bought into the fallacy tying the uninsured to emergency room use more than supporters of health reform did. Remember, before the ACA, the idea of a universal mandate for coverage was espoused by conservatives, not liberals.
The emergency department utilization issue is pretty simple, actually. If you have insurance you’re less worried that going to the emergency room is going to wipe you out financially.
The ACA was passed in 2010. Here’s a few posts I wrote about the emergency department and insurance in the years leading up to it:
The uninsured may seek a greater proportion of their care in the ER (or maybe not) but they tend to avoid the medical system in general. Meanwhile, insured people are at least as likely as the uninsured to use the ER in a given year.
That doesn’t mean the health care reform bill is a bad idea. It just means that absent other reforms –namely increasing throughput in physicians’ offices through the use of smarter scheduling and webVisits– it will lead to higher costs and lower service levels.
But just for a minute, assume we did achieve universal insurance coverage. There would still be plenty of problems; costs might be even higher. A common argument is that costs would go down as uninsured patients head to less costly primary care physicians rather than emergency rooms for routine treatment. That would be great if true, but there’s evidence that insured patients use the emergency room more than uninsured patients. That could be because the uninsured tend to avoid treatment unless they’re in dire straits. Once the same patient has insurance he or she may want to test it out.
The perception that the uninsured are clogging up emergency rooms is a dangerous one, not only because of the bias it represents against the less fortunate, but also because it drives incorrect policy assumptions. One of the arguments for universal health insurance in Massachusetts and California was that it would [at least partly] pay for itself by shifting patients from the ER to primary care.
Actually what happens is the insured use all modes of treatment more. Providing people with health insurance means they’ll consume more of everything, as we’re seeing in Massachusetts.
Image courtesy of Stuart Miles at FreeDigitalPhotos.net
—May 5, 2015