One of the big problems for hospitals and emergency rooms prior to the Affordable Care Act was the number of uninsured people going to emergency rooms for regular care. Emergency rooms saw dire situations made worse by not going to a doctor before problems became acute. These visits would cost more than an office visit and, more often than not, patients could not pay.
This would lead to hospitals having to absorb the costs, with patients feeling the pinch via higher insurance premiums and higher out-of-pocket costs. One of the touted benefits of the ACA was that more people would be able to afford health insurance and get the care they need before simple things became major problems.
While†more than 8 million newly insured are receiving billions in healthcare benefits for less money, visits to the emergency room arenít seeing an immediate decrease.
The Los Angeles Times reports that in the first few months of ACA, the number of patients visiting the emergency rooms of Los Angeles County public hospitals increased by only 1.7 percent. This was substantially lower than previous years which saw increases as high as 5 percent for patients not requiring hospitalization. At the same time, however, thousands still went to the emergency rooms of private hospitals, often because their insurance would cover it.
The reasons why people are flocking to the ER are complicated.
For public hospitals, much of it has to do with choice. Many of the patients that relied on the public healthcare system now have more choices to seek care, even those that are covered under Medicaid. The unintended side effect for this is that the county hospitals may now be left with those that have no insurance and are most likely not able to pay. States that have refused to expand Medicaid have already seen many of their rural hospitals suffer due to the lack of coverage for those that didnít qualify for subsidies, but canít get covered under Medicaid.
Critics of the ACA have used this new data to claim that it isnít working and is putting peopleís lives at risk. They cite a study published earlier this year highlighting Oregonís expansion of Medicaid led to an increase in ER visits, including the fact that they were 40 percent more likely to go to the ER. These critics are conveniently ignoring that this study was from 2008 and it was an experimental expansion not related to the ACA, which had not even been written. While unrelated to the study, it should be noted that Oregonís actual implementation of the ACA is deemed one of the worst in the nation.
Nevertheless, these critics are also ignoring a major reason for the increase: People are going to the ER because they had nowhere else to go.
Some industry experts suggest that ER visits are due to a sudden influx of patients seeking care put off due to not being able to afford a doctor. Many of these patients tried to go to the doctor, however, but there was no appointment available. One major problem with the increase in the number of people who can now afford to go to the doctor is that there just arenít enough of them to go to.
Parents arenít able to get their child to a pediatrician due to a sudden rash or fever because there was no way the doctor would be able to see them, forcing an hours long visit to an emergency room.† It is common for new parents to ask for pediatrician recommendations, yet itís still hard to find one. Many pediatricians no longer take insurance because of the costs of administration.† If they do take new patients, they only take newborn siblings, already having more patients than they can handle.
After six years, I have learned to schedule my sonís annual checkup three months in advance.
The increased number of people with insurance has led to a situation where the ER is the only place to get timely care. I, too, have been forced to go to the emergency room in the middle of the afternoon because my doctor was unable to see me with my great PPO plan and the matter required attention that I couldnít wait three weeks to deal with. During my wait in the emergency room, which would be hours because they determined I wasnít dying, I would overhear dozens of patients checking in with the same opening line: My doctor told me to come here.
This was before Obamacare even existed.
The delivery of care of our healthcare system will take time to adjust to the influx of millions that are entering. In addition to new doctors in all disciplines, there will need to be new ways to administer the networks that are efficient and timely. The reliance on ERs is not a reflection of the quality of care, most of which is still very good, or a failure of landmark legislation. It is a glaring reminder that affording health care isnít enough. Patients must also have access to the care they need when they need it.
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