A new cost of Obamacare: Surging emergency room usage


By Sally C. Pipes



Emergency room usage has spiked in recent years.

That’s the depressing finding from a new survey by the American College of Emergency Physicians — and it’s endangering those who need emergency care. The survey concluded that three in four ER doctors have experienced a surge of new patients since the Affordable Care Act became law.

That’s no coincidence. Obamacare relies on Medicaid — the federal health insurance program for the poor — to expand health coverage. Since 2013, more than 11 million people have gained insurance through the program.

At the same time, there hasn’t been a surge of primary care physicians taking on Medicaid patients. As a result, millions of enrollees can’t access doctors and have turned to the ER for basic care. Lawmakers must redesign Medicaid’s finances to reverse this trend.

Medicaid patients have been relying on emergency room care for some time. A report released last year by MIT and Harvard researchers discovered that adult Medicaid beneficiaries use emergency rooms 40 percent more frequently than the uninsured.

That’s because finding a doctor is difficult — nearly one in three physicians refuses to accept new Medicaid patients. The reason? Medicaid sometimes pays physicians only half the market price for basic medical services.

This increases everyone’s healthcare costs. For non-urgent care, an ER trip costs an average of $580 more than a visit to a primary care physician.

Without reform, this problem will only worsen.

According to the Association of American Medical Colleges, the United States will be short nearly 63,000 doctors this year. By 2025, that number will double. With physicians unable to handle Obamacare’s flood of new patients, all Americans could be turning to emergency rooms for routine care.

Obamacare has only made this problem worse. By strapping caregivers with costly new rules and bureaucratic procedures, it’s prompted many to hang up their stethoscopes. According to a survey from the Physicians Foundation, 39 percent of doctors plan to retire early.

To reduce this strain, Congress must reform how it funds Medicaid.

Currently, the federal government picks up between 50 to 75 percent of a state’s Medicaid expenses — no matter how large the total. Officials should switch to a block grant system, providing states with a single lump sum at the year’s start, indexed to the size of the state’s Medicaid population. Local policymakers would be free to spend that money as they see fit.

Block grants would encourage states to get the greatest bang for their buck. They’d have a reason to find innovative ways to encourage more physicians to join the pool and decrease ER visits.

For example, states could allow Medicaid patients the freedom to choose their own private coverage. That would empower enrollees to take an active role in their healthcare.

The president has acknowledged the problem of excess ER usage. In 2009, he said, “those of us with health insurance are also paying a hidden and growing tax for those without it — about $1,000 per year that pays for somebody else’s emergency room.”

But Obamacare only increased this hidden tax. The law expanded coverage — but coverage doesn’t work if patients can’t find a doctor. To solve this problem, Congress must reform the way the government finances public insurance through block grants.

Until then, Obamacare will succeed in ensuring that the ER is the only doctor in town.

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Sally C. Pipes is President, CEO, and Thomas W. Smith Fellow in Health Care Policy at the Pacific Research Institute. Her latest book is The Cure for Obamacare (Encounter 2013).

By Sally C. Pipes

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