January 3rd, 2014

Giving people Medicaid does not decrease their ER visits

According to a study of the Medicaid expansion in Oregon—which offers particularly fertile ground for research because new Medicaid participants were selected randomly from among those eligible—giving people Medicaid increases ER use, rather than decreasing it as Obama and the Obamacare proponents and so many others had predicted.

Why on earth would this be any sort of surprise? I know, I know: the idea was that people only go to the ER because the law requires them to be treated there and they have no alternatives; if they were covered for doctor visits, the argument went, they would prefer that alternative. But what the study found was that people who were covered by Medicaid used both resources more, which makes perfect sense because, as Megan McArdle points out, “as the basic laws of economics tell us, when you reduce the price of something, people usually want to consume more of it.”

Not only are they consuming ER visits at a faster clip, but they are consuming them more for lesser ills rather than greater ones. McArdle wrote “reduce the price,” but unless I’m mistaken, Medicaid doesn’t just reduce the price, it eliminates it for the recipient. Any health care system involving no payments at all must do one of two things to keep cost and usage down: ration care, and/or start requiring co-pays of some sort.

Those who theorized otherwise were either just saying what they needed to say to pass the law, or truly believed that people would act in ways that they considered “rational” and reduce their ER use, preferring doctor visits and preventive care. But there’s nothing in the current Medicaid system (at least, not so far as I know) that incentivizes doctor visits over ER visits. In fact, I can think of a couple of things that do the opposite: it may be hard to get a doctor to accept Medicaid at all, and even if he/she does accept it there’s usually a wait to get an appointment, whereas an ER may make you wait a few hours but they will see you that day.

What’s even more important is a fact that’s become sort of lost in the shuffle, but which first came out last May in another study of the Oregon Medicaid situation (I wrote about it here), and that is the fact that the Medicaid expansion didn’t improve the new recipients’ health, either, in terms of basic markers such as blood pressure and cholesterol. McArdle points this out, too, “Only two large-scale random tests have ever been done on health insurance, and both have come back with the same surprising result: giving people Medicaid, or more generous health insurance, doesn’t seem to significantly improve clinical measures of good health.”

And yet health economist Jonathan Gruber, who was one of the Obamacare “architects” and whom I’ve written about before, had this to say in response to yesterday’s study report:

I would view it as part of a broader set of evidence that covering people with health insurance doesn’t save money…That was sometimes a misleading motivator for the Affordable Care Act. The law isn’t designed to save money. It’s designed to improve health, and that’s going to cost money.

I don’t know whether Gruber himself was originally citing that “misleading motivator” of cost-saving back in the build-up to the passage of Obamacare, but I do recall—despite Gruber’s use of the passive voice in the quote above—that Obama and the Democrats were certainly touting cost-saving. But Gruber’s emphasis on “improving health” is probably a “misleading motivator” as well. As I wrote back in May, Obamacare might just be “making a show of the fact that we ‘care’ without really helping anyone”—and doing so at great cost to the middle class and above.

32 Responses to “Giving people Medicaid does not decrease their ER visits”

  1. Inkraven Says:

    Health insurance does not equal health care. Somewhere along the line, those in the free [government service] for all started conflating the two.

  2. Sam L. Says:

    Nooooooo. Who woulda thunk it?

  3. baklava Says:

    Results do not matter to liberals.

    Therefore liberals are insane.

    Common sense is lacking and as dependency grows the nation becomes weaker

  4. LTEC Says:

    The idea that the ER is a costly way of providing medical care, is common but obviously wrong. It would only be true if the ER is badly managed.

    If the ER is well managed, then they plan for the type of patients they expect (on average) to have, hiring the appropriate number of the appropriate kinds of doctors, and doing appropriate triage. This system does not give people personal physicians and care, but it is the most efficient way possible of providing care to a large number of people.

  5. Mr. Frank Says:

    Adding millions of people to the demand side of health care and not adding to the supply side (doctors and nurses and equipment) was a recipe for disaster.

  6. Matt_SE Says:

    As someone else said, “Is there anything about this law that wasn’t a lie?”

  7. JuliB Says:

    In IL, there’s no co-pay for a Medicaid visit to the ER (IRRC), but a $3 or $5 for a doctor’s visit. Ridiculous.

  8. AlB Says:

    Oregon observed this study and has a brilliant solution. They essentially are going to limit the number of ER visits by each Medicaid “client”. I think that’s called rationing!! Another Obama lie. On more than one occasion he said that ER visits and their costs were a major problem. He said that by passing Obamacare and giving everyone insurance, they’ll stop using the ER and will visit their primary care physician. WRONG!!! They will continue to use the ER BECAUSE IT IS FREE!!!!!

    Does BO even understand the concept of Truth???

  9. Lizzy Says:

    Considering how few doctors are now (understandably) not accepting Medicaid patients, it should be no surprise that these people instead go to the ER. Not only can they show up w/out an appointment but the doctors on duty can’t refuse them based on their being on Medicaid.
    = = =
    And how surprising is it that yet another Obama promise on Obamacare has expired?

    NRO’s Jim Geraghtey said it best: Every Obama promise comes with an expiration date. Every. Promise.

  10. Lizzy Says:

    Argh – Double negative in the 1st sentence! It’s few doctors that now accept medicaid patients…

  11. KLSmith Says:

    The real problem isn’t the liberals that believed The Lies. It is that so many ill informed moderates did.

  12. lacune Says:

    These unnecessary ER visits really drive up the costs of care for those who actually pay for it.

    As anyone who has ever worked in an ER will (if allowed to speak honestly) will tell you, a large part of business are Hispanic people with little or no English presenting with cases of the “ay-yi-yi’s”. They show up holding their belly and groaning “ay, yi-yi”, but can’t elaborate on their pain, tell you where exactly it is, how long they’ve had it, or any other relevant symptoms in English or even in Spanish. If you try to examine them, the moment you touch any part of them, they start writhing as if in mortal agony and screaming “ay, yi-yi!” At that point, you’re pretty much obligated to order an expensive CT scan on the patient because, God forbid, what if something is seriously wrong? 99% of these unnecessary scans on these patients show simple constipation.

    Meanwhile, ER doctors are constantly being told by administrators to cut down on the number of scans they order. That means if you present to the ER, tell them your timeline of symptoms in a logical manner, you are less likely to get a scan (even if you need one) because the doctor will at least have a clue as to what is going on and how to treat it. Unfortunately, lung cancer can present and look a lot like a pneumonia, so you might only get a chest x-ray and not the more confirmatory CT scan and get sent out of the ER with antibiotics to treat your supposed pneumonia. Then the tumor grows for another 4 months until you start coughing up blood and doctors start taking this x ray finding seriously.

    Meanwhile, while you miss out on the scan that could have caught your lung cancer before it was inoperable, uncommunicative illegals with mild constipation are getting million dollar workups that force doctors to skimp on you. And its only going to get worse now that they KNOW their care is free rather than merely SUSPECTING it is.

  13. Geoffrey Britain Says:

    It’s not about results or truth or health care, it’s about the accumulation of power. The greater the number of ‘dependents’ and, categories dependent upon, the larger the dependency class, which translates to votes and votes equal political power.

    Political power is essentially de facto control.

    All the talk by the left about ‘caring’, ‘rights’, ‘inequality’ and ‘disparate privilege’ is a dog and pony show for the rubes. Whether the rube is a gullible low-info voter or a naive, ivory tower leftist/liberal is entirely incidental to the furtherance of the agenda.

    The hard left doesn’t care about the truth of the matter, much less the best way for a society to operate, they only care about the accumulation of power, so as to control others and they’re willing to use ANY means necessary to gain that power.

    “Political tags – are never basic criteria. The human race divides politically into those who want people to be controlled and those who have no such desire.” – Robert A. Heinlein

  14. J.J. Says:

    All of these things were known and presented by men such as Drs. Tom Coburn (R-OK) and John Barrasso (R-WY) during the debates and after the passage of the law. This is not unexpected. Except by the pie-in-the-sky progressives who thought their plan was perfect. Just like all the socialist bureaucrats that don’t understand markets and human behavior.

    Is there anything good about this law? Thus far, I have seen nothing.

  15. Don Carlos Says:

    JJ-
    Of course there is nothing good about or in this law.
    Kindly read Goeffrey Britain’s words, immediately preceding yours, and take them to heart.

  16. Lizzy Says:

    Not only does Obamacare give the federal government control over the care we receive, but it provides them access to our health care records.

    And what a coincidence that just today Obama signed two executive orders related to expanding the use of citizens’ mental health records for gun background checks. There will be no end to the reasons they “need” to access our private health records, and these needs will always lead to them exerting more control over our lives.

  17. Ymarsakar Says:

    Government money merely makes you into their pet. You start to take on domesticated qualities. You start being unable to live out on the wild on your own.

  18. JoyO Says:

    Among Obama’s lies besides that “if we liked our healthcare plan, we could keep them. If we liked our doctor, we could keep our doctor, WAS “Your costs will go down $2,500.”

  19. KLSmith Says:

    lacunae: exactly. Citizens that have paid taxes for decades will be rationed out of healthcare while people that may have just crossed the border get plenty of care for free. Social Justice.

  20. Mr. Feverhead Says:

    Yeah right, they never thought it was going to make healthcare affordable, that’s why it is called the “Affordable Care Act”

  21. Matt_SE Says:

    @KLSmith

    If this gets much worse, “social justice” is going to start being enforced by the second amendment against the ruling class.

    And they will have deserved it.

    If I were a borderline-terminal patient and got screwed out of coverage, I’d resolve to take some Washington D.C. SOB out with me.

  22. Wm Lawrence Says:

    As noted by several commenters, ACA was never about health care per se. There is nothing in the bill that would work to improve the quality or quantity of health care. It is about the government seizing the medical care resources currently available from those who could previously afford them and redistributing them to their parasitic voter base.

    The idea of removing profit from healthcare sounds good to the mushy socialist mind, but it can never lead to improvements in healthcare.

    If you think that medicine has advanced as far as it can go then maybe this is the plan for you because the life blood of medical research and development is profit.

  23. Caedmon Says:

    Meanwhile in Merrie England

    After 70 years of the National Health Service people still take minor complaints to the ER although Doctor’s Office visits are free.

  24. bob sykes Says:

    Actually, going to the ER makes perfectly good sense both for the patient and the ER. In many parts of the country (like where I live), the ER is the only medical service that is available evenings, weekends and holidays. Recently, we got an Urgent Care facility that supplements the local ER, but even it isn’t open 24/7.

    LTEC is exactly correct. A properly managed ER is no more expensive than a doctor’s office. The whole discussion over the effect of the ACA on ER visits is nonsensical.

  25. Don Carlos Says:

    LTEC and bob sykes assert something without any evidence in support. Typical Leftist thinking.

    Let’s see some data to address their avowed conclusion that “A properly managed ER is no more expensive than a doctor’s office.” Which is de facto BS. What doctor’s office manages both chronic, non-acute minor complaints, the “ay-yi-yi” crowd, and major vehicular trauma causing both major abdominal, orthopedic and neurologic trauma? Regardless of cost? Leftists, pagh.

  26. kit Says:

    I read Iacune’s comment with interest because I witnessed an ER situation that was so unfair to the really needy patients.
    Late one night we brought a seriously ill patient with chronic progressive MS to the ER by auto because he preferred it to an ambulance. You wait hours to be attended to in a busy ER. There was a group of Hispanics with what appeared to be a VERY non emergency. They were savy enough, even though they spoke no Englsh, to use their phone to call an ambulance. They went down the block to meet the ambulance and back they came and were given priority because of the ambulance entry.
    I brought this to the attention of the desk and she told me Medicaid people do it all the time.
    They can really work the system and working the system is a very selfish thing to do. It will get worse.

  27. LTEC Says:

    Don Carlos –

    Obviously it is more expensive to do an appendectomy than to prescribe antibiotics. All we are saying is that examining a patient and prescribing antibiotics is no more expensive for a well-run ER than for a doctor’s office.

    And I am NOT a leftist. And it is my impression that most of the wailing about the “misuse” of ER is by leftists.

  28. Ymarsakar Says:

    It’s not like they expected to slaves to be given limited supplies of life saving health resources or life rejuvenation treatments.

    What’s the point of having a slave class if you can’t dispose of them and breed them like chickens?

  29. Lizzy Says:

    ER abuse isn’t only an expense issue, it’s a misuse of resources issue. It’s intended for emergencies, and tying up resources on non-emergency health issues diverts care away from the true emergencies. I had a very unpleasant experience with this when I took my son to the ER one evening for complications from a heart cath he had earlier that day. The waiting room was overflowing with people and not an English speaker among them (I knew this because I had to wheel my distressed son around in his stroller around the joint while waiting for him to be admitted). It finally took my mother going all Shirley McClain/Terms of Endearment on the hospital staff to get him to the front of the line.

    Sure, the ERs could (and probably have to) increase staff to handle the Medicaid overflow, but wouldn’t that be in effect turning them into ad hoc doctor’s offices, diluting their stated purpose? How is this different from idiots who use 911 to complain about an incorrect McDonalds order?

  30. neo-neocon Says:

    bob sykes:

    Whether you consider the debate “nonsensical” or not, the point is that it was given as one of the reasons for the passage of Obamacare.

  31. Don Carlos Says:

    LTEC:
    I suspect you hold ER opinions without 1) having spent any time there as a patient since EMTALA, 2) having ever worked in an ER as doc or nurse, or 3) had any administrative or financial responsibility in the running of an ER.
    If so, how does this differentiate you from BHO in health care issues?

  32. Snackeater Says:

    A good friend is an ER nurse in Illinois and she says that the trend now is to feign an emergency and call 911 for what turns out to be minor aches and pains. That way, they not only get a free ambulance ride to the ER, and receive free care, they get seen faster and they get a cab voucher for the ride back home. And if they are there during mealtime, they get free food to boot.

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Previously a lifelong Democrat, born in New York and living in New England, surrounded by liberals on all sides, I've found myself slowly but surely leaving the fold and becoming that dread thing: a neocon.
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