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Editorial: Expansion of Medicaid didn’t curtail use of ER

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This outcome wasn’t what was predicted, though it shouldn’t be a surprise.

Part of President Barack Obama’s pitch for passage of the Affordable Care Act was that when people who lacked health insurance coverage had it, costs would go down because fewer people would use emergency rooms as their primary care providers.

A new study shows the exact opposite is possible as Medicaid is extended to millions of low-income uninsured Americans.

The study found that new enrollees from a Medicaid expansion in Oregon five years ago actually used emergency rooms 40 percent more often than other low-income people who were not selected by lottery for the expansion.

It also showed the newer Medicaid clients were going to emergency rooms with conditions that could have been treated in a doctor’s office or in an urgent care clinic, both of which would be less expensive than an ER visit.

In addition to weekends and nights, ER visits increased during regular business hours when doctors’ offices and urgent care centers would be open.

Men accessed the ER more often than women, and according to the authors’ earlier research Medicaid patients also went to doctors’ offices more often.

This study and earlier ones together indicate Medicaid expansion increases health care spending and does not significantly improve the patients’ physical health in measurable ways.

Whether the research will be predictive of how people just now enrolling in Medicaid access the health care system nationwide remains to be seen. But it raises concerns about whether people’s habits can be changed.

New Mexico expects to enroll about 170,000 new people into its Medicaid system, Centennial Care, under the ACA. That should be seen as a positive in a state where poverty reigns. Of the approximately 2 million people who call New Mexico home, more than a quarter – or about 560,000 people – already have been receiving their health care through Medicaid.

Under Centennial Care, there is no cost to enroll but some enrollees may be charged minimal co-payments for emergency room visits and for prescriptions. An Associated Press story last summer when New Mexico’s plan was approved by the federal government said prescription co-pays were to be $3 for brand name drugs, and emergency room co-pays could be as low as $5.

That is considerably less than a person with private insurance typically shells out for an ER co-pay and provides little to no incentive not to use the quickest or easiest method of accessing treatment.

When something is free or nearly so, it can be under-appreciated and over-used.

There is almost no reason to expect that won’t happen as Medicaid is expanded nationwide under the ACA, unless the feds impose realistic co-pays.

Getting health care costs under control is especially important since premium-paying consumers and their employers will still be footing most of the bill.

This editorial first appeared in the Albuquerque Journal. It was written by members of the editorial board and is unsigned as it represents the opinion of the newspaper rather than the writers.

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