Medicaid increases visits to emergency rooms

It has been a article of faith among health care proponents that extending things like Medicaid would lower costs by encouraging poor people seek routine care rather than showing up at the emergency room when things got really bad. A recent MIT study indicates this is not true. In fact, people who received Medicaid were 40% MORE likely to use ERs than their similar neighbors who did not have insurance.

Experiments where you can test one variable and hold others constant are the gold standard in science. In a social sciences, it would be good to assign subjects randomly and see how one change affects a group and a control. We usually cannot do this, but natural experiments exist. In this case, the State of Oregon had a lottery that randomly granted Medicaid insurance to poor people. The results are not promising.

"On average, the Medicaid recipients visited ERs in 12 Portland-area hospitals 1.4 times during an 18-month period, compared with 1.02 visits for the control group without insurance. Using $435 as the average cost of an ER visit, the researchers calculated that Medicaid increased annual ER spending by $120 a covered person. Hospitals often end up footing the bill for uninsured patients."

The only "success" of ObamaCare so far is to get more people to sign up for Medicaid. This will end up costing the system in both outlay costs and increased medical costs.

States that didn't take the "free" money from Obama are looking smarter now.

In general the MIT experiment showed "This randomized, controlled study showed that Medicaid coverage generated no significant improvements in measured physical health outcomes in the first 2 years, but it did increase use of health care services, raise rates of diabetes detection and management, lower rates of depression, and reduce financial strain."

So there is good news and bad news. People didn't get any healthier, but they felt better about themselves. A very liberal result.

Posted by Christine & John at January 2, 2014 7:06 PM
Comment #375418

YOU TOUCH MEDICAID I’M GONNA’ BOX YOUR EARS IN. That’s the only thing I get.

Posted by: simpleheaded at January 3, 2014 3:06 PM
Comment #375419

C&J, as a Republican, you have to admit that changing behavior on a societal basis is NOT and overnight thing. Those previously without health care, have no General Practitioner, and are not accustomed to going to one instead of the E.R. Their behavior will change from ER to GP and specialists, but, it will take some time. Most humans do not venture into new behaviors without reluctance and resistance. Republicans know this all too well. In time, behavior will catch up with new opportunity in a reasonable and efficient fashion. Also, please consider that those previously without insurance, no doubt allowed minor conditions to become serious ones, and now that they have insurance, going to the ER to take care of these serious conditions is expected, and will abate as they are returned to healthier states of being dealing with new symptoms the way the rest of the insured population does.

Posted by: David R. Remer at January 3, 2014 3:31 PM
Comment #375420


I think we may be looking at a complex result where we make an input in an attempt to do one thing and provoke another.

I admit a bias against too much medicine. I think people go to the doctor TOO often for unimportant things. I was recently reading an article re knee surgery. On balance, it has no positive effects and may provoke worse injury. Same goes for back surgery. It is not to say that SOME people do not benefit, but too many people are doing it.

Poor people in general have bad habits. That is how they became and stay poor. I can well envision some poor sucker taking greater chances with his health because he figures he will get it fixed by his insurance. Insurance presents that kind of moral hazard.

Posted by: CJ at January 3, 2014 3:59 PM
Comment #375422

C&J, insurance does present moral hazard consequences. But, risk taking is prized in our society and is the backbone of our capitalist and investor systems. So, it is not practical to argue against risk taking and for capitalism in the same breath. There are myriad reasons for poverty and poor people, not the least of which is the simple economic reality that we live in systems in which there is an infinite demand for finite supply systems, which dictates a reality of income hierarchies, regardless of the political system a society rests upon. Acknowledging this reality, requires one to back away from the argument that poor habits are the sole or even primary cause of poverty and poor people. If one is honest, one has to accede to the reality that poverty and poor people have myriad causes which include, genetics, social and economic conditions and the state of technology substitution for human labor for profit or greed purposes.

Posted by: David R. Remer at January 3, 2014 4:09 PM
Comment #375424

There is a pretty good article on Daily Kos about this topic, with many links. Basically, it makes the same point David Remer makes, namely, that the pattern of ER usage among new Medicaid recipients changes over time. I would add that using Portland OR as an example of a typical city for ER usage among new Medicaid recipients is probably not a good idea. Portland has an unusually supportive attitude towards the homeless…

The crux of the matter will come when red states confront the consequences of refusing federal Medicaid money to provide health care coverage for the poor. I keep talking about this, and I would urge you to consider issue as it is outlined in the following article:

The attempt to sabotage Obamacare will turn into an absolute catastrophe for the 21 states with GOP controlled governments.

As Republican Governor Jan Brewer (AZ) says about Obamacare:

“It’s pro-life, it’s saving lives, it is creating jobs, it is saving hospitals.”

Posted by: phx8 at January 3, 2014 6:25 PM
Comment #375425


Calculated risk taking is good and necessary. Just being stupid is not the same thing.

Re poverty - there are lots of causes, but the cause we can identify is habits and behavior. In the American past and still in some limited places, you can stay poor even if you have good habits and behaviors. But it is unlikely.

Anybody can be poor for a while. I have been poor and probably you have too. But if you stay poor for a lifetime, you are either the most unlucky person in the world, or you are doing something wrong. Recall the old saying that the only thing constant in all your failures is you.

If a person works regularly, even at low wages, stays faithfully married, doesn’t abuse drugs or booze and generally does not antagonize other people, the chances that such a person will be poor are very low. I am not saying that everyone can be rich, but most poverty results from what people do, not from the conditions.

We do indeed have a chicken-egg argument. Poor people have bad habits because they learned bad habits being poor. But if we want to reduce poverty we have to look at the pressure point, which is behavior.

Progressives, BTW, can take credit for creating this. Various government programs from the Morril Act to even parts of the Great Society have helped the worthy poor climb out of poverty. We are now left with a hard core of bad actors.

Posted by: CJ at January 3, 2014 6:31 PM
Comment #375426


Re long term behavior change - How wold they know that it changes over time? The study has not been going on that long. Liberal have assumed that usage would drop. Data is showing that this assumption is probably in error.

Re consequences for red states - You are more interested in politics; I am more interested in what is the real truth. Indeed, in the political short term, taking the Federal money is a good thing. This is exactly what is wrong with liberalism. It bribes people with their own money, even when the bribes are leading them to do things not effective in the long run.

Posted by: CJ at January 3, 2014 6:37 PM
Comment #375427

I know it trends toward conspiratorial thinking but, shouldn’t we be looking at the ACA thru a corpocratist lens? By now it should be readily clear that:

The ACA was passed as pretty much a blank sheet of paper, to be filled in well after the mid-term elections. The idea was to just get something passed offering insurance to the uninsured. Everything else will follow later, years later.

Surely, the most biased ACA supporter can see that the web site ‘failure’ was/is nothing more than a delaying tactic. And, we have all this supposed confusion as to whether one is covered or not covered; by design dear readers, you must have faith.

Be assured that behind the scenes the corpocracy is working with parters in the EU, etc, to ‘harmonize’ ins policies that will make it to daylight over the next few years.

Way to early to suggest that those insured for free will use the emerg room more than before. By 2016 one might be able to discuss ins as something other than a pipedream, IMO.

Otherwise - - -

Posted by: Roy Ellis at January 3, 2014 6:40 PM
Comment #375428

Following is an interesting case. I agree with the state of Texas for the reasons stated.

Planned Parenthood of Texas Surgical Health Services v. Abbott

“Planned Parenthood is challenging a state of Texas abortion law. The provision currently at issue is a requirement that abortionists have admitting privileges at a local hospital so that they cannot escape post-operative emergency care of their patients.”

Posted by: Royal Flush at January 3, 2014 6:44 PM
Comment #375429

Royal Flush,

Perhaps I am unusually dense, but what does admitting privileges have to do with post-operative emergency care? Hospital ERs cannot refuse to admit an emergency patient simply because the referring physician doesn’t have admitting privileges.

In addition, the absence of admitting privileges would not allow a physician who performed an abortion to “escape” liability for providing and/or referring a patient for post-operative emergency care.

Posted by: Rich at January 3, 2014 8:48 PM
Comment #375449

C&J, you of all people should acknowledge that individual people come with a bell curve of talents, abilities, and capabilities. Though individuals may fall in the outer sector of least talents, abilities, and capabilities, if they can function in a full time job they should receive a living wage for their full time work. As it stands today, such persons, invaluable to the businesses that employ them, remain at poverty level wages. This whole Republican/Libertarian rant that if one is not wealthy, one is disabled in some way voluntarily or otherwise, is bullshit for the most part. Affording health care has to be part of that living wage. If it isn’t, both the employee and business owner suffer as a result of that employees lacking health care, in the long run. Of course, some conservatives would argue that workers are just a replaceable tool like a ball point pen out of ink. That view separates today’s conservatives from a large segment of the independents and liberals.

Posted by: David R. Remer at January 7, 2014 2:53 PM
Comment #375585

CJ said: “Re poverty - there are lots of causes, but the cause we can identify is habits and behavior”.

That is the cause you can identify as a Republican because it fits your tax saving policy agenda, people be damned.

Sociological and psychological research over decades has identified many causes for poverty including racism, anomolous cultural norms, and even political redistricting for wealth class segregation in both the private and public sectors, not to mention economic downturns caused by greedy capitalists.

Posted by: David R. Remer at January 10, 2014 5:46 PM
Comment #375646

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