title: Medicaid Expansion In 2014 Did Not Increase Emergency Department Use But Did Change Insurance Payer Mix.
abstract: In 2014 twenty-eight states and the District of Columbia had expanded Medicaid eligibility while federal and state-based Marketplaces in every state made subsidized private health insurance available to qualified individuals. As a result, about seventeen million previously uninsured Americans gained health insurance in 2014. Many policy makers had predicted that Medicaid expansion would lead to greatly increased use of hospital emergency departments (EDs). We examined the effect of insurance expansion on ED use in 478 hospitals in 36 states during the first year of expansion (2014). In difference-in-differences analyses, Medicaid expansion increased Medicaid-paid ED visits in those states by 27.1 percent, decreased uninsured visits by 31.4 percent, and decreased privately insured visits by 6.7 percent during the first year of expansion compared to nonexpansion states. Overall, however, total ED visits grew by less than 3 percent in 2014 compared to 2012-13, with no significant difference between expansion and nonexpansion states. Thus, the expansion of Medicaid coverage strongly affected payer mix but did not significantly affect overall ED use, even though more people gained insurance coverage in expansion states than in nonexpansion states. This suggests that expanding Medicaid did not significantly increase or decrease overall ED visit volume.
authors: Jesse M. Pines (pinesj@gwu.edu) is the director of the Center for Healthcare Innovation and Policy Research and a professor of emergency medicine and of health policy and management at George Washington University, in Washington, D.C.
authors: Jesse M
authors: JM
authors: Pines
authors: Mark Zocchi is a senior research associate in the Center for Healthcare Innovation and Policy Research, George Washington University.
authors: Mark
authors: M
authors: Zocchi
authors: Ali Moghtaderi is a postdoctoral fellow in the Center for Healthcare Innovation and Policy Research, George Washington University.
authors: Ali
authors: A
authors: Moghtaderi
authors: Bernard Black is the Nicholas D. Chabraja Professor at Northwestern University, in Evanston, Illinois.
authors: Bernard
authors: B
authors: Black
authors: Steven A. Farmer is the associate director of the Center for Healthcare Innovation and Policy Research and an associate professor of medicine and of health policy and management at George Washington University.
authors: Steven A
authors: SA
authors: Farmer
authors: Greg Hufstetler is vice president, Reimbursement and Regulatory Affairs, at Reimbursement Technologies Inc., a billing and financial management company in Conshohocken, Pennsylvania.
authors: Greg
authors: G
authors: Hufstetler
authors: Kevin Klauer is chief medical officer-emergency medicine at TeamHealth Inc., a national multispecialty integrated physician group practice based in Knoxville, Tennessee.
authors: Kevin
authors: K
authors: Klauer
authors: Randy Pilgrim is the enterprise chief medical officer at Schumacher Clinical Partners, a multispecialty physician management and staffing group based in Lafayette, Louisiana.
authors: Randy
authors: R
authors: Pilgrim
mesh_terms: D016208:Databases, Factual; D004636:Emergency Service, Hospital / Q000191:economics / Q000706:statistics & numerical data*; D005260:Female; D018166:Health Care Reform / Q000191:economics; D006801:Humans; D019458:Insurance Coverage / Q000191:economics / Q000706:statistics & numerical data; D007349:Insurance, Health, Reimbursement / Q000191:economics / Q000639:trends*; D008297:Male; D008484:Medicaid / Q000191:economics* / Q000706:statistics & numerical data; D058991:Patient Protection and Affordable Care Act / Q000191:economics* / Q000458:organization & administration; D012044:Regression Analysis; D012189:Retrospective Studies; D014481:United States
keywords: Access To Care; Health Economics; Health Reform; Insurance Coverage < Insurance; Medicaid