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Why ER Visits Are High: Obamacare is Working But the Health System Isn’t

Why ER Visits Are High: Obamacare is Working But the Health System Isn’t

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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Photo credit: Thinkstock

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85 comments

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4:43AM PDT on Sep 5, 2014

Isn't this what ObamaCare was supposed to fix? We seem to be in the same place we were before.

9:05AM PDT on Sep 1, 2014

health care shouldn't be about profits.....but it is too much

9:05AM PDT on Sep 1, 2014

...we need to go back to a society that encourages and rewards education and desire to go into a profession that does society good....in this case medicine.....

....we need to then financially support college and medical school students heading into medical careers especially those going into primary care fields.....family medicine, general medicine, pediatrics and OB-GYN...and those willing to go work in inner city and rural locations.........too many students want to go where the $$$ is such as specialties, suburban hospitals, etc.....

I work in urban Minneapolis and for the past decade the majority of younger physicians in our clinic system have been foreign born graduates...the US trained students are all looking to work in suburbs where they won't have to "work so hard" in that they want an 8 to 5 clinic job without weekends,night or inpatient hospital responsibility.....very few want to stay in inner cities or go rural and very few want to stay in primary care.....

lets find out why and work to solve these issues....

6:30PM PDT on Aug 29, 2014

The hospitals should hire.

5:33AM PDT on Aug 29, 2014

Thanks for posting.

5:22AM PDT on Aug 29, 2014

Thank you

9:56PM PDT on Aug 28, 2014

Complaining about the ACA system doesn't change the simple supply/demand problem of not having enough PCPs. We can either import more doctors, or give PAs and NPs more authority, which incidentally, is something most physicians do NOT want and actively push back against. I'm not entirely in favor of it myself--working in the field, I've seen plenty of NPs who got their education decades ago, work in a very specific area, and don't have a real breadth of current knowledge. Some are great though, so it's a tough call. The physicians at least do have some continuing education demands to meet. However, the sharpest people tend to go into surgery, including the sadly lucrative plastic arena, or specialties like gastro or dermatology, not the slog that is primary care. With the population growing, I can't see any alternatives other than lowering the med school bar, or importing from countries who are pumping out more med school grads.

9:44PM PDT on Aug 28, 2014

We have three "after hours" clinics in our rural area. They are a great alternative to the ER when you need to see a doctor, but no appointment is available.

8:14PM PDT on Aug 28, 2014

Thanks Crystal for the very insightful article.

6:32PM PDT on Aug 28, 2014

When I looked into signing up for healthcare, all the policies I saw were $700 plus and all had at least a $5,000 deductible. I eventually found a Christian group that had a much, much better deal, but still has a $5,000 deductible. Sure, I'll be covered if I have some catastrophic illness or accident, but otherwise I'm essentially not covered for any of the "smaller" charges. Office visits are out of the question unless I have the money to pay it myself. I don't know all the reasons people go to ER when it isn't a life or death emergency, but this could be part of it - people just can't afford an office visit. We should learn from Australia, they have much better quality care, better accessibility, and the per capita cost for health care is much lower. The US has the most expensive healthcare in the world and among the worst quality care in the developed world. As long as politicians get "kickbacks" from lobbyists, this situation will only get worse.

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