Medicaid Increases Emergency-Department Use: Evidence from Oregon's Health Insurance Experiment

Taubman, Sarah; Allen, Heidi; Wright, Bill; Baicker, Katherine; Finkelstein, Amy

doi:10.1126/science.1246183

Cited by 527 publications

(471 citation statements)

References 20 publications

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“…In the year after health insurance acquisition, hospital admissions increased by 30% in one year for those who gained insurance (31). Similarly, those who acquired Medicaid insurance had a 40% relative increase in emergency department visits compared with control subjects (32).…”

Section: Will the Affordable Care Act's Expansion Of Medicaid Remedy mentioning

confidence: 96%

Medicaid Expansion under the Affordable Care Act. Implications for Insurance-related Disparities in Pulmonary, Critical Care, and Sleep

2014

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The Affordable Care Act was intended to address systematic health inequalities for millions of Americans who lacked health insurance. Expansion of Medicaid was a key component of the legislation, as it was expected to provide coverage to low-income individuals, a population at greater risk for disparities in access to the health care system and in health outcomes. Several studies suggest that expansion of Medicaid can reduce insurance-related disparities, creating optimism surrounding the potential impact of the Affordable Care Act on the health of the poor. However, several impediments to the implementation of Medicaid's expansion and inadequacies within the Medicaid program itself will lessen its initial impact. In particular, the Supreme Court's decision to void the Affordable Care Act's mandate requiring all states to accept the Medicaid expansion allowed half of the states to forego coverage expansion, leaving millions of low-income individuals without insurance. Moreover, relative to many private plans, Medicaid is an imperfect program suffering from lower reimbursement rates, fewer covered services, and incomplete acceptance by preventive and specialty care providers. These constraints will reduce the potential impact of the expansion for patients with respiratory and sleep conditions or critical illness. Despite its imperfections, the more than 10 million low-income individuals who gain insurance as a result of Medicaid expansion will likely have increased access to health care, reduced out-of-pocket health care spending, and ultimately improvements in their overall health.

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Section: Will the Affordable Care Act's Expansion Of Medicaid Remedy mentioning

confidence: 96%

Medicaid Expansion under the Affordable Care Act. Implications for Insurance-related Disparities in Pulmonary, Critical Care, and Sleep

2014

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“…20 Finkelstein et al (2012) [27] provides more details on the lottery, and supporting evidence on the assumptions required to use the lottery as an instrument for Medicaid coverage. Previous work has used the the lottery as an instrument for Medicaid to examine the impact of Medicaid on health care utilization, financial well-being, labor market outcomes, health, and private insurance coverage (Finkelstein et al, (2012) [27], Baicker et al, (2013) [6], [4]), and Taubman et al, (2014) [43]). …”

Section: Medical Spending Mmentioning

confidence: 99%

“…3 References for these outcomes include, respectively Currie and Gruber (1996a,b) [17], [18], Garthwaite, Gross and Notowidigdo (2014) [29], and Cutler and Gruber (1996) [20]. 4 For more detail on these results, as well as on the experiment and affected population, see Finkelstein et al, (2012) [27], Baicker et al (2013) [6], [43], and [4]. 5 The results of the Oregon Health Insurance Experiment have received extensive media coverage, but the media drew a wide variety of conclusions as the following two headlines illustrate: "Medicaid Makes 'Big Difference' in Lives, Study Finds" (National Public Radio, 2011, http://www.nber.org/oregon/press.html) versus "Spending on Medicaid doesn't actually help the poor" (Washington Post, 2013, http://www.washingtonpost.com/blogs/rightturn/wp/2013/05/02/spending-on-medicaid-doesnt-actually-help-the-poor/).…”

Section: Introductionmentioning

confidence: 99%

The Value of Medicaid: Interpreting Results from the Oregon Health Insurance Experiment

Finkelstein

Hendren

Luttmer

2015

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We develop and implement a set of frameworks for valuing Medicaid coverage for recipients and apply them to welfare analysis of the Oregon Health Insurance Experiment, a Medicaid expansion that occurred via random assignment. Our baseline estimates of the welfare benefit to recipients from Medicaid per dollar of government spending range from about $0.2 to $0.4, depending on the framework, with a relatively robust lower bound of $0.2. At least two-fifths -and as much as four-fifths -of the value of Medicaid comes from a pure transfer component, as opposed to its ability to move resources across states of the world. In addition, we estimate that Medicaid generates a substantial transfer to non-recipients of about $0.6 per dollar of government spending.

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“…Such ED utilization has been attributed to barriers in timely and efficient access to primary care, lack of transportation, cost of care, wait times, and opening hours (4)(5)(6)(7)(8)(9). Some studies suggest that patients insured through the Affordable Care Act (ACA) will increase ED utilization rates (10,11).…”

Section: Introductionmentioning

confidence: 99%

Patient Motivators for Emergency Department Utilization: A Pilot Cross-Sectional Survey of Uninsured Admitted Patients at a University Teaching Hospital

Lozano¹,

Ogbu²,

Amin³

et al. 2015

The Journal of Emergency Medicine

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, Abstract-Background: During the past several decades, emergency department (ED) increasing volume has proven to be a difficult challenge to address. With the advent of the Affordable Care Act, there is much speculation on the impact that health care coverage expansion will have on ED usage across the country. It is currently unclear what the effects of Medicaid expansion and a decreased number of uninsured patients will have on ED usage. Objective: We sought to identify the motivators behind ED use in patients who were admitted to a university teaching hospital in order to project the possible impact of health care reform on ED utilization. Methods: We surveyed a convenience sample of uninsured patients who presented to the ED and were subsequently admitted to the inpatient setting. Results: Our respondents sought care in the ED primarily because they perceived their condition to be a medical emergency. Their lack of insurance and associated costs of care resulted in delays in seeking care, in reduced access, and a limited ability to manage chronic health conditions. Thus, contributing to their admission. Conclusions: Affordability will reduce financial barriers to health care insurance coverage. However, efficient and timely access to primary care is a stronger determinant of ED usage in our sample. Health insurance coverage does not guarantee improved health care access. Patients may continue to experience significant challenges in managing chronic health conditions. Ó 2015 Elsevier Inc.

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Medicaid Increases Emergency-Department Use: Evidence from Oregon's Health Insurance Experiment

Cited by 527 publications

References 20 publications

Medicaid Expansion under the Affordable Care Act. Implications for Insurance-related Disparities in Pulmonary, Critical Care, and Sleep

Medicaid Expansion under the Affordable Care Act. Implications for Insurance-related Disparities in Pulmonary, Critical Care, and Sleep

The Value of Medicaid: Interpreting Results from the Oregon Health Insurance Experiment

Patient Motivators for Emergency Department Utilization: A Pilot Cross-Sectional Survey of Uninsured Admitted Patients at a University Teaching Hospital

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