Study: Medicaid Expansion Increases ER Use

Expanding Medicaid coverage significantly increased emergency department use among previously uninsured adults in Oregon, according to a study published in Science.

In 2008, Oregon enacted a limited Medicaid expansion by drawing about 30,000 names at random from a waiting list of nearly 90,000 people. Those selected by the lottery gained coverage if they completed the Medicaid application and met eligibility requirements. The researchers evaluated administrative data from EDs of hospitals in the Portland area for about 25,000 Medicaid lottery participants.

They found gaining Medicaid coverage significantly increased overall ED use during the 18-month study period by 0.41 visits per person, or 41 percent, relative to the average of 1.02 visits per person among lottery participants who did not receive Medicaid coverage.

The increase in ED use occurred even though those newly covered by Medicaid also displayed an increase in self-reported primary care use, including prescriptions, preventive care and outpatient physician visits, according to the study.

The researchers wrote these findings could prove useful in evaluating the costs and benefits of Medicaid expansion, which has become a controversial issue in many states since the passage of the Patient Protection and Affordable Care Act.

The healthcare reform law gives states the option of expanding their Medicaid programs starting this year to cover adults earning up to 138 percent of the federal poverty level. As of last month, 25 states (including Oregon) and Washington, D.C., had decided to move forward with expanding their programs, two states opted to explore expansion after 2014 and 23 states are not moving forward with expansion at all, according to the Kaiser Family Foundation.

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