News & Commentary

ED visits: After the ACA, the uninsured–Medicaid seesaw


The proportion of emergency department visits by Americans without insurance decreased from 14% to 8% from 2013 to 2016, while visits by those with Medicaid coverage increased from 26% to 34%, according to a cross-sectional study published in April in JAMA Network Open. Lead author Adam Singer, MD, told Managed Care in an email exchange “that many expected ED visits to drop after the ACA due to presumed better access to primary and preventive care. However, the increase in ED visits continued, though more patients had Medicaid and less were uninsured.” Both the launching of the ACA exchanges and the expansion of Medicaid under the ACA occurred in 2014.

Annual U.S. emergency department (ED) visits, 2006 to 2016

Total ED visits, no., millions

Source: Singer AJ et al., JAMA Network Open, April 19, 2019

Utilization trends of the ED by insurance status after the ACA

Source: Singer AJ et al., JAMA Network Open, April 19, 2019

Singer, of Stony Brook University, and colleagues also examined trends in hospital discharges. They found that the proportion of hospital discharge of patients without insurance was steady at about 6% from 2006 to 2013, then dipped to 5% (2014) and 4% (2016).

In terms of how this affects the bottom line, the researchers played the more-study-is-needed card, saying that “additional work” should be done to examine how these trends have affected out-of-pocket costs for patients and overall costs of care.”

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