Lead author Sayeh Nikpay, assistant professor of health policy at Vanderbilt University Medical Center, said the increase was “modest,” with 2.5 more emergency room visits per 1,000 people in states that expanded Medicaid coverage under the ACA.
Uninsured care for those patients decreased by 5.3 percent during that same period after 2014, she said.
“Our results suggest that the coverage part of the ACA Medicaid expansion is working,” Nikpay said. “People who need care can access care. However, it isn’t surprising that emergency department visits didn’t fall because even if you gained Medicaid coverage, the ACA did little to make primary care more accessible, for example, offering evening and weekend hours.”
The study analyzed patient visits in 25 states – 14 that expanded Medicaid coverage and 11 that did not – and found the share of visits covered by private insurance remained constant for expansion states and increased by several percentage points for non-expansion states.
Gains in insurance coverage in non-expansion states were almost entirely in the form of private coverage, not Medicaid.
“Medicaid expansion had a larger impact on the health care system in places where more people were expected to gain coverage,” Nikpay said. “The share of emergency department visits covered by Medicaid increased by 8.8 percentage points in expansion states, as compared to non-expansion states.
“The change in total visits was twice as large in Kentucky, where most childless adults were ineligible for Medicaid at any income level before 2014, as compared to Hawaii, where childless adults were already eligible for Medicaid above the poverty line.”