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Bob Herman reports at, using 2014 data, that Medicaid now pays for more ER visits than any other source. The trend is shown in the graph below and represents, in great part, the expansion of Medicaid under the Affordable Healthcare Act (ACA).

In October 2016, Forbes reported (…/medicaid-expansion-causes-surg…/2/…): “On March 3, 2010, a few weeks before the ACA passed Congress, President Obama said, “taxpayers currently end up subsidizing the uninsured when they’re forced to go to the emergency room for care…You can’t get…savings if those people are still going to the emergency room.” A few months after passage of the law, then-Speaker of the House of Representatives Nancy Pelosi said, “the uninsured will get coverage, no longer left to the emergency room for medical care.”

The bottom line:

– An Oregon study of 25,000 Medicaid insureds (…/medicaid-expansion-boosted-emergency-r…) showed that Medicaid enrollees increased their emergency room visits by 40 percent over the first 15 months.

– Also, researchers found no measurable health benefits in the Medicaid group for several chronic conditions, including hypertension, high cholesterol and diabetes.

– And, there is little evidence that Medicaid coverage makes the physician’s office and the ER substitutes for one another.

– The experts were wrong.

– But a two-year study from 57 upstate NY counties from 1985 to 1987 ( foreshadowed later outcomes of ACA, while also suggesting that hospitals may be making it “too easy” to access this high cost treatment To quote: “This study has demonstrated that Medicaid ER use is associated with Medicaid primary care use. High levels of ER use are related to low levels of primary care use and vice versa. It appears that the primary care can occur in physicians’ offices, freestanding clinics, and outpatient departments. The availability of (or the pressure on) hospitals is an explanatory factor in ER use. Hospitals that are under less pressure have a higher level of ER use than hospitals that are under greater pressure. Higher rates of Medicaid eligibles as a percentage of the county’s population are associated with higher rates of ER use. It is hoped that these findings will help plan future policies towards addressing these issues.”

– NICHE expects that the Centers for Medicare & Medicaid Services (CMS) will give free-standing emergency rooms a fresh look leading to more regulation and fee restrictions.