One of the topics I occasionally get asked to speak to groups about is health care policy. I’ve followed national and state health care policy, mostly from an economics angle, for the past 7 years pretty consistently.
One of the points used to sell the Affordable Care Act was that health care costs are high because of over-utilization of the emergency room for care. In particular, the allegation was that is was the primary place the uninsured get their care. So, the argument went, everyone having insurance would mean that the emergency rooms would be less crowded.
A simple study of E/R use, particularly in posts-health-reform Massachusetts, would have shown that this isn’t the problem. In fact, the only segment of the society that used the E/R at a higher per-person rate than others is the Medicaid population. And this is not because the Medicaid patient has a predisposition to emergencies or towards using the emergency room…it’s because so many states pay so little for Medicaid reimbursements that many doctors have stopped taking new Medicaid patients, which leads to the E/R being their only access point.
A new study has come out confirming what many of us knew going into the PPACA’s passage, that increasing the Medicaid roles increases Emergency Room use. And now the arguments regarding the law’s intentions are changing:
“I would view it as part of a broader set of evidence that covering people with health insurance doesn’t save money,” says Jonathan Gruber, a health economist at the Massachusetts Institute of Technology, who has also studied Oregon’s Medicaid expansion but is not affiliated with this study. “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.” (emphasis mine)
The law isn’t accomplishing any of its stated goals. The stated goals were laudable. But the law’s economic drivers will accomplish worse, less affordable care and I am convinced that come this time next year there will be more Americans uninsured than there are now. Time will tell.