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Spike in ER use after Medicaid expansion is only temporary, study says

O'Connor Hospital in San Jose, Calif., is encouraging uninsured patients to sign up for coverage in the emergency room.
Sarah Varney for NPR
O'Connor Hospital in San Jose, Calif., is encouraging uninsured patients to sign up for coverage in the emergency room.

A new UCLA study could rekindle the debate over whether expanding access to Medicaid leads to increases in the use of emergency rooms.

A study in Oregon published earlier this year found that when that state expanded Medicaid coverage to thousands of previously uninsured low-income people in 2008, costly emergency room visits spiked, whereas supporters of the expansion had expected to see a decline.

The findings gave fodder to opponents of the Affordable Care Act, which provides for states to expand their Medicaid programs to cover more low-income people.

But now a UCLA study is suggesting that such spikes in ER use are only temporary. 

The study, by researchers at the Center for Health Policy Research, looked at ER use among low-income Californians who signed up for a special statewide, county-run program that gave them health coverage from 2011 until the end of 2013, at which point they became eligible for Medi-Cal – California’s version of Medicaid -- under the Affordable Care Act.

The study found that, like in Oregon, emergency room visits jumped as soon as people started getting benefits through the program, called the Low Income Health Program. But it also found that the spike occurred only among those people who had not had health coverage and not sought medical care in the previous 12 months.

And the UCLA researchers found that the spike among those people didn’t last. Within a year, their rate of ER visits had plummeted to levels comparable to other people in the Low Income Health Program, some of whom had been getting coverage through a different statewide program as far back as 2007.

Dr. Gerald Kominski, one of the study’s authors, said the findings suggest that an expansion of Medicaid is likely to increase ER visits - and therefore medical costs - in the initial months of an expansion, as people rush to take care of medical problems they had previously delayed getting treated.

But those costs "are dramatically reduced by year two and then become comparable to other individuals who have been receiving care on a more regular basis," Kominski said.

Kominski said this is good news for California and other states that have expanded Medicaid, because beginning in 2017, those states will begin to assume some of the costs of the expansion that were previously covered by the federal government.