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More ER Patients Now Paying With Medicaid, Report Says

Courtesy Sts. Mary & Elizabeth Hospital

The number of emergency room visits in Kentucky hasn’t gone up much since Medicaid expanded or people started getting coverage on the individual market. That’s according to a new report from the Foundation for a Healthy Kentucky.

Before the Medicaid expansion, many uninsured Kentuckians were going to the emergency room instead of a primary care doctor for non-emergency treatment because they could not be turned away.

Now, more of them have Medicaid coverage, but they’re using the coverage for the same type of ER visit. The percentage of people in the emergency room with Medicaid coverage did increase quite a bit by 2015, with almost half  covered by Medicaid. That’s up from 30 percent in 2012.

The cost of emergency care that could have been treated in a primary care office is estimated to be around $30.8 billion annually. Private insurance companies often have higher co-pays for an ER visit to deter people that could otherwise go to urgent care or their family doctor.

But with Medicaid, that’s not the case. There are no financial incentives for people not to go. One of the original intentions of the Affordable Care Act was to reduce unnecessary ER visits, though that hasn’t quite panned out as expected in Kentucky or nationwide.

“The Affordable Care Act in its initial sales pitch thought that we would have a fairly substantial decrease in the number of people using the ERs," said Ben Chandler, CEO of the Foundation for a Healthy Kentucky. "And what we found out instead is that the ER usage has been pretty stable. About as many people are using them now as they were then.”

Chandler said using the ER for primary care is "inefficient.”

More than 400,000 people gained insurance coverage through the expansion of Medicaid to include adults without children and those earning up to around $15,000 a year. Meanwhile, around 100,000 people got insurance through the creation of the state-run exchange, Kynect.

Jim Waters, president of the libertarian-leaning think tank Bluegrass Institute, said the only way to get Medicaid patients away from the ER is to charge co-pays that are higher than for primary care.

“People who have private coverage are not using the ER more, and the reason is because they’re having to think about in terms of, is my condition worthy of an ER visit, or should I go and have a regular doctor’s visit,” Waters said.

A big reason for that is convenience and time, according to a 2013 study from the Robert Wood Johnson Foundation. Primary care physicians often have long wait-times for first visits, and sometimes don’t have same-day appointments. In the ER, patients always get seen eventually.

Some hospitals have implemented programs to target patients that could receive care elsewhere, and either send them to a primary care doctor from the ER for an immediate appointment, or set them up with an appointment post-visit.

Many primary care offices also advise patients to go straight to the ER if they believe they’re having a life-threatening emergency, when the primary care doctor could perhaps treat the patient.

President-elect Donald Trump has vowed to repeal and replace the ACA, which would include the Medicaid program and state exchanges. Instead, he’s proposed to give states big blocks of money to manage Medicaid however they choose.

Because of this, Gov. Matt Bevin will likely get the changes to the program he wants, including co-pays and premiums that could help drive down ER usage.

Lisa Gillespie is WFPL's Health and Innovation Reporter.

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