Post-ACA, ED visits up 7.6% among frequent users in California

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The number of frequent emergency department users, or those who visit the ED at least four times a year, increased in California after the ACA took effect, according to a recent study published in Health Affairs.

Researchers used data from California's Office of Statewide Health Planning and Development to compare the characteristics of Californians who frequently used the ED before and after several of the ACA's changes, like Medicaid expansion, took place.

The study authors found prior to the ACA's major coverage expansions, frequent users accounted for 7.9 percent of ED patients. After the changes, 8.5 percent of ED patients were frequent users, representing a 7.6 percent increase in frequent users across the time periods.

However, researchers found "after changes in the health status and coverage sources of the ED patient population were accounted for, the likelihood of being a frequent ED user decreased in the two years following implementation of the major coverage provisions of the ACA," according to the report. "Still, with the sizable increase in ED patients covered by state Medicaid programs and higher baseline odds of frequent ED use among Medicaid patients relative to those with other coverage, there has been an overall increase in both the share and the absolute number of ED patients who are frequent users."

The study authors concluded while greater enrollment in Medicaid and managed care coverage can help insure high-need patients, a large enrollment influx over a short period of time can pressure health plans and state budgets.

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