Emergency rooms still packed, despite ACA coverage gains

The Centers for Disease Control and Prevention (CDC) found that emergency room (ER) usage changed little between 2013 and 2014, despite the implementation of the Patient Protection and Affordable Care Act (ACA) (P.L. 111-148) and increases in the number of insured adults. The number of U.S. adults (about 20 percent) who seek ER care has remained mostly stable over the last decade. This report supports last year’s emergency physician polling results indicating that ER visits were increasing (see ER visits grew since coverage mandate took effect, Health Reform WK-EDGE, May 13, 2015).

ER use

The CDC found that the percentage of adults making one visit to the ER remained the same in both years (11.4 percent), and the number of adults making two or more visits barely dropped, from 6.8 to 6.6 percent. The number of adults with private insurance who made two or more visits increased by 0.3 percent. The largest drop was observed among those enrolled in Medicaid making one visit to the ER, which went from 19 percent to 16.7 percent. However, Medicaid enrollees making two or more visits each year only dropped by 0.2 percent.

The main reason for ER use for those covered both through private insurance and Medicaid, as well as the uninsured, related to seriousness of the medical problem, for the following reasons: provider advised the patient to go to the ER, problem was too serious for a doctor’s office, only a hospital could help, or the patient arrived by emergency vehicle. The uninsured were by far more likely to visit the ER due to lack of access to other providers, with 15.8 percent in 2013 and 15.4 percent in 2014 citing this as their reasoning. By contrast, only 4.8 percent of those privately insured stated this as their reason in 2014, a drop of 0.9 percent from the previous year. Medicaid enrollees citing this reason jumped 1.8 percent in 2014, to 7.5 percent.

ACA impact

Prior to the ACA, some reports showed that newly insured adults were more likely to use the ER. This trend was supported by 2014 studies from Massachusetts and Oregon, while a California study indicated that this rate-increase effect is a short one. The report emphasized that the first full year of ACA implementation seemed to have little to no effect on ER use, but noted the difficulties in assessing the ACA’s effect based on existing studies.