Why Our Emergency Rooms Will Be More Crowded
There was a disturbing juxtaposition of news items this week.
First, the Congressional Budget Office came out with new forecasts showing that, under health reform, the number of Americans enrolled in the Medicaid program will be even greater than expected. Even before these new numbers emerged, it was estimated that more than 15 million Americans would be moved into the Medicaid program because of the new eligibility thresholds established by the Patient Protection and Affordable Care Act.
We saw a preview of the potential impact of Medicaid expansion through a study issued by the Annals of Emergency Medicine. The study, authored by Dr. Atil Ginde of the University of Colorado School of Medicine, found that, between 1999 and 2009, 39.6 percent of Medicaid patients visited an emergency room compared to just 17.7 percent of privately insured patients.
The reason, Dr. Ginde determined, that Medicaid patients are more than twice as likely to be in an ER is because not only are they in poorer health generally, but they are less likely to be seeing a primary care physician. This situation is not likely to improve once health reform is fully implemented. In fact, it could severely worsen. As Dr. Ginde put it, “Our findings are particularly worrisome in light of the additional 16 million people who will be added to the Medicaid rolls over the next decade. The shortage of primary care providers in the U.S. seems to affect Medicaid patients disproportionately and more harshly.”
And, I would add, Medicaid’s significantly lower reimbursement rates compared to private insurance make it even more difficult for physicians to see Medicaid patients.
If the CBO trends, showing fewer people receiving employer-based private coverage and more individuals enrolled in Medicaid, continue, policymakers are going to have to revisit the mechanisms being used to provide Americans with health coverage.