(LOUISVILLE, Ky – November 17, 2016) Medicaid is covering an increasingly larger proportion of emergency room visits in Kentucky since the Affordable Care Act was implemented, according to a report released today by the Foundation for a Healthy Kentucky. Last year, 46.9 percent of ER visits were paid for by Medicaid, up from 30.2 percent in 2012. Conversely, charity and self-pay covered visits to the ER dropped from 23.2 percent in 2012 to 5.9 percent last year, the report said.
“We’re seeing an expected shift in payment from charity care to Medicaid in these early years of the Affordable Care Act implementation, but the ACA is only a part of the answer to reducing the volume of ER use,” said Ben Chandler, president and CEO of the Foundation for a Healthy Kentucky. “ER visits have remained fairly steady in the Commonwealth since 2012, with what appear to be only minor fluctuations. Long-term improvement in Kentucky’s health means enacting policy changes that lead more Kentuckians to seek out better preventive care and regular doctor visits. That’s a much less expensive approach, and it results in much better long-term health than going to the hospital in an emergency.”
The findings are in the latest report from an ongoing study of the impact of the Affordable Care Act (ACA) in Kentucky, commissioned by the Foundation in 2015. According to the report, Kentucky hospitals reported 2.1 million emergency room visits in 2014, nearly identical to the number of visits in 2012. Visits rose slightly to 2.2 million in 2015, but more long-term data is necessary to determine whether that represents a year-to-year fluctuation or an actual increase, the report said.
An earlier report emanating from the same study showed that Kentuckians often have what appear to be rational reasons for continued high use of the ER, including medical emergency, being directed to the ER by their doctor, and needing care when other medical facilities weren’t open (see 2016 Semi-Annual Report, p. 35).
Other studies have revealed a pattern of initial increase in ER use after Medicaid expansion followed by a slowing down in ER visit growth rates in several states, including Connecticut, New Jersey, Colorado and Oregon, which expanded Medicaid eligibility under special waivers prior to the ACA. (See 2016 Deloitte study here; report regarding Oregon’s experience here; and report from California’s experience here.) Moreover, the research shows that the growth in ER use is not attributable to the uninsured (see here).
“ER use has been rising for two decades across the country, but it’s not the uninsured who are going more often,” Chandler said. “It’s going to take a combination of delivering care differently, ensuring that people have a regular doctor they can get in to see when needed, better care coordination, and more education before we see a sustained reduction in ER use.”
A copy of the latest report, the 6th quarterly snapshot of the Study of the Impact of the ACA Implementation in Kentucky, is available here.
About the Foundation for a Healthy Kentucky
Since the Foundation opened its doors in 2001, it has invested more than $26 million in health policy research and pilot project grants across the Commonwealth. Funded by an endowment, the mission of the Foundation is to address the unmet health care needs of Kentuckians by developing and influencing health policy, improving access to care, reducing health risks and disparities, and promoting health equity. Follow the Foundation on Twitter and on Facebook, or visit our website at www.healthy-ky.org.
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Bonnie J. Hackbarth