Three-quarters of the 2,099 doctors responding to the nationwide survey conducted by the American College of Emergency Physicians indicate they have seen an increase in emergency room (ER) visits since the Affordable Care Act (ACA), better known as Obamacare, went into effect on January 1, 2014.
In the same survey, 28 percent of the respondents say ER use has “increased greatly.”
What providers are witnessing daily in the ER is not what the Obama administration promised would happen, says Dr. Richard Armstrong, a surgeon who practices in Michigan and serves as a board member of the Docs4PatientCare Foundation.
“Obamacare obviously did nothing to reduce the incentive for patients to use the ER as their primary care doctor,” Armstrong said.
High ER Primary Care Costs
All people make their choices based on incentives, and yet Obamacare did nothing to require co-pays from Medicaid patients, Armstrong says.
“It’s not unusual to see a Medicaid patient who simply has a headache to come to the emergency room instead, because it won’t cost them anything to get some Advil [there], which they could buy themselves at the drugstore across the street,” Armstrong said.
This drives up the cost of care for hospitals who believe they are bound by law to treat these patients and don’t want to turn patients away. A 2013 study by the Robert Wood Johnson Foundation reported a visit to the ER costs about $580 more on average than the same treatment administered in a primary care doctor’s office.
Government Picking Plans Does Not Work
One of the stated primary goals of Obamacare is to expand Medicaid, even though it’s long been known Medicaid patients use the ER more than patients with other means of paying, says Dr. John O’Shea, a Pennsylvania surgeon who also serves as senior fellow in The Heritage Foundation’s Center for Health Policy Studies.
The problems are worse in states with the greatest shortage of primary care physicians, which are the same states experiencing the largest expansion of Medicaid, O’Shea says. This situation will be exacerbated if government projections of primary care physician shortages come true. Some experts predict the United States could have a shortage of primary care physicians exceeding 20,000 doctors by 2020.
O’Shea says the cost of health care is also being driven up by government officials picking plans for low-income patients rather than allowing market forces to control the process, including allowing these patients to choose care that works best for them.
“This is another serious reminder the government picking plans, even for Medicaid patients, just doesn’t work,” O’Shea said. “It would be better for the government to heavily subsidize patients and let them choose the care that works best for them, rather than what is happening now.”
But instead of doing the hard work of addressing specific problems within the health care system, such as the lack of access to primary care doctors by Medicaid patients, O’Shea says it was politically easier just to declare millions of previously uninsured people were now covered.
“It looks really good politically, and that’s what they went for,” O’Shea said.
Jim Waters ([email protected]) is president of the Bluegrass Institute, a free-market think tank in Kentucky.
Marketing General, Inc., “2015 ACEP Poll Affordable Care Act Research Results,” Prepared for the American College of Emergency Physicians, March 2015: https://www.heartland.org/policy-documents/2015-acep-poll-affordable-care-act-research-results
Quality Field Notes, Number 1, “What We’re Learning: Reducing Inappropriate Emergency Department Use Requires Coordination with Primary Care,” Robert Wood Johnson Foundation: http://www.rwjf.org/content/dam/farm/reports/issue_briefs/2013/rwjf407773
The National Center for Health Workforce Analysis, “Projecting the Supply and Demand for Primary Care Practitioners Through 2020,” U.S. Department of Health and Human Services, Health Resources and Services Administration, November 2013: http://bhpr.hrsa.gov/healthworkforce/supplydemand/usworkforce/primarycare/