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Report: Affordable Care Act has had little impact on ER use

Emergency Department Visits in the Past Year (by coverage type; non-elderly Kentuckians)
Emergency Department Visits in the Past Year (by coverage type; non-elderly Kentuckians)

Nearly three years into implementation of the Affordable Care Act (ACA) in Kentucky, emergency room use has neither decreased nor increased substantially, despite predictions that the law might have a strong impact.

About the same proportion of Kentuckians went to the ER in 2016 as before the ACA, although the total number of ER visits increased slightly. A new report recently released by the Foundation for a Healthy Kentucky also found that Kentucky children and adults up to age 64 who had public health insurance such as Medicaid and the Kentucky Children’s Health Insurance Program (KCHIP) were significantly more likely to say they had used an ER in the prior year than those with private coverage; that held true both before and after the ACA went into effect in Kentucky.

“One of the benefits supporters hoped would result from the ACA was reduced use of ERs, where treatment is a lot more expensive,” said Foundation CEO Ben Chandler. “What we found is that ER visits declined for several months after the ACA first went into effect, but then they rose again. The explanations are multifaceted, but it turns out Kentuckians had some very rational reasons for heading to the ER. The bottom line is that many of the benefits of having insurance coverage for the first time in life will take a while to play out, and that’s certainly the case with ER use.”

The report goes on to state, “…research in some other states has also shown increased emergency department (ED) use soon after gains in health insurance coverage, but then evidence that ED use stabilized or declined a few years later. This appears to be related to newly insured individuals beginning to find more-appropriate ambulatory care settings for their usual source of care instead of the ED. Tracking these measures over time will allow Kentucky to determine whether ED use in the commonwealth stabilizes or declines in future years.”

The report found that one in four (25.5 percent) Kentuckians said in 2015 that they visited an ER in the past year, about the same proportion as before the ACA. By examining data from Kentucky hospitals, the report also found the total number of ER visits dropped the first three quarters of 2014 and then rose to a level in 2016 that was 4.5 percent higher than in 2012. The percentage of Kentuckians who use the ER is significantly higher than for the United States overall, where the rate is fewer than one in five (18.3 percent).

In 2016, nearly three in 10 non-elderly adults said the reason they went to the ER is because they had a medical emergency; another nearly three in 10 said no other facilities were open at the time they needed care. Slightly more than 7 percent said their doctor directed them to an ER. Only 3 percent said they went because they didn’t have a regular doctor.

The report also found that the proportion of ER visits that hospitals reported as charity care or self-pay dropped from 23 percent in 2012 to less than 6 percent by the third quarter of 2016. At the same time, the share of ER visits covered by Medicaid rose from almost one-third of visits in 2012 to almost half in 2015 and the first three quarters of 2016.

“Hospitals have benefited from the ACA because they’re having to eat less of the cost of caring for uninsured Kentuckians,” Chandler said. “That’s especially important for smaller, rural hospitals.”

The report, “Emergency Department Utilization in Kentucky,” is part of the Foundation’s ongoing study of the impact of the ACA in Kentucky.