Six months in, Obamacare impact on emergency room visits unclear
BY MONIFA THOMAS Health Reporter June 22, 2014 8:56PM
A trauma patient in the emergency room at Mount Sinai Hospital. Though intended for urgent care, emergency rooms often were the first choice for the uninsured — something the Affordable Care Act is intended to change. | Chandler West/For Sun-Times Media
Updated: July 24, 2014 6:12AM
Six months after new health insurance options took effect for millions nationwide, most Chicago-area hospitals say they haven’t seen a noticeable change in the number of emergency room visits.
The theory was that people who previously didn’t have insurance would no longer go to emergency rooms for treatment; under the Affordable Care Act, commonly called Obamacare, they would make a doctor’s appointment, lowering health care costs by reducing ER visits. Emergency rooms charge higher prices for minor illness and injury care than other ambulatory care settings, because they offer more services.
But so far, at least, there is little evidence of an impact.
Advocate Health Care, which operates 11 acute-care hospitals in the Chicago area, for instance, has seen no increase in people making doctor’s appointments or visiting the ER, said Dr. Lee Sacks, executive vice president and chief medical officer of Advocate Health Care.
Northwestern Memorial Hospital, Rush University Medical Center and safety-net hospitals such as Mount Sinai Hospital and Swedish Covenant Hospital also couldn’t point to a significant impact in their emergency rooms.
“Our sense is that it is still too early to pinpoint exact impact on volumes and visits,” said Dr. James Adams, chief of the emergency department for Northwestern Memorial HealthCare.
Hospitals said they have noticed that more Medicaid patients are coming in — for ER care or to see a doctor for an appointment since January.
“We are definitely seeing an uptick in Medicaid patients” in the ER,” Swedish Covenant spokesman Nick Przybyciel said. “But the jury is still out on the financial impact that these newly enrolled Medicaid patients will ultimately have on [safety-net] hospitals like us.”
The law created two new health insurance options It provided tax credits for middle-income people to buy private insurance through an online marketplace. And it gave states the option to expand Medicaid, the federal-state program for people with low incomes. The earliest Illinois residents could access either option was Jan. 1.
More than 217,000 people in Illinois had signed up for a private insurance plan as of April; an additional 287,000 people in Illinois signed up for Medicaid by then, according to Get Covered Illinois, the state-run marketplace.
No information has been provided on how many of these people had insurance before the law.
Nationally, the American College of Emergency Physicians polled more than 1,800 emergency room doctors in May and found that nearly half reported increases in ER patients since Jan. 1.
Overall, 37 percent called it a slight increase; 27 percent hadn’t seen a change, and 23 percent said ER volume was down since Jan. 1.
Many health experts noted that even those who now have insurance through the Affordable Care Act may still go to the emergency room for non-emergency care.
“People may have tried to call doctors in the networks in the plans that they’ve enrolled in, only to discover that the doctor says they don’t take that coverage. . . . Or the doctor says I’m taking the coverage, but I can’t see you for two months,” said Sara Rosenbaum, a health policy professor at George Washington University.
The issue, said Dr. Rebecca Parker, an emergency physician at two hospitals, is that “coverage does not equal access.”
“So as people are getting their coverage, many of whom are getting it through the Medicaid program, that doesn’t necessarily mean that the system is available for access to care,” she said.
Health experts said it would likely take time to see a change in behavior for previously uninsured people. Going to the emergency room for routine treatment had become a habit; they also may still choose the ER because they think it is more convenient and offers better care, according to a 2013 analysis by the Robert Wood Johnson Foundation.