The Massachusetts Division of Health Care Finance and Policy in the Commonwealth’s Department of Health and Human Services recently highlighted a continued rise in the number of people using Bay State emergency rooms.
According to the report, emergency room visits rose by 9 percent between 2004 and 2008, to about 3 million visits a year, and the number continues to rise. The the state’s reform of health care had been expected to reduce the number of emergency room visits. Massachusetts granted “universal” health care coverage to all its residents in 2006 under Republican Governor Mitt Romney.
According to John Graham, director of health care studies at the Pacific Research Institute, the notion the uninsured would no longer use hospital emergency rooms to receive medical care, but would instead set up appointments with doctors, is propaganda made by politicians.
“Politicians refuse to consider the wealth of data that debunks the myth that uninsured residents drive the emergency room crisis,” Graham said. “In Canada, where everyone has so-called ‘universal’ coverage, the ER crisis is perpetual. In the U.S., there is evidence from a number of states that Medicaid and privately insured people dominate the ERs, not the uninsured.”
Emergency Rooms in Crisis
Graham maintains Massachusetts’ reforms provided no solution for emergency room overcrowding.
“Because the Massachusetts health insurance regulations allow people to wait until after they have become sick to sign up for insurance, in exchange for paying a relatively small fine, the healthy will be uninsured and the sick insured, all things equal,” Graham said. “Therefore, it is not surprising that the ERs are in crisis after the ‘reform’.”
Dr. John Ayanian of Harvard Medical School’s Department of Health Care Policy says he’s not surprised by the increase in emergency room visits with the state granting “universal” health care coverage.
“In a nutshell, the people using the emergency now are both the uninsured and the [health insurance] covered, but much of the use is by the insured all along, particularly older patients who have Medicare coverage and have complex illnesses, because they require more access [outside office hours] during the evenings and the weekends,” Ayanian said.
Ayanian says solving a problem of insurance coverage does not solve a problem of access.
“It’s two separate issues. Plus, those uninsured in the population are usually the younger and healthier groups, and they are not using the emergency as much in comparison,” Ayanian said.
Usage Could Rise Nationally
Graham expects ObamaCare to worsen the effect of excessive emergency room visits throughout the nation because it expands the Medicaid rolls while cutting Disproportionate Share Hospital (DSH) payments.
“Obamacare will have similar consequences to [those in] Massachusetts,” said Graham. “Plus, it will make the fiscal situations of hospitals worse because it cuts back Disproportionate Share Hospital payments, which are designed to compensate for the large number of Medicaid patients in ERs, while putting 16-to-18 million more people on Medicaid.”
Thomas Cheplick ([email protected]) writes from Cambridge, Massachusetts.