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Study: Medicaid Expansion Brought More ER Trips, But Fewer Uninsured

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Kentucky and other Medicaid expansion states are seeing an increase in overall emergency room visits.

Still, fewer uninsured people are going to the ER under the Affordable Care Act.

In 2014, states with expanded Medicaid access saw an 8.8 percent increase in the share of ER visits covered by Medicaid, according to a study published in the Annals of Emergency Medicine. The share of visits by those without insurance decreased by 5.3 percent. Those with private insurance remained the same in expansion states.

The study is based on a comparison of 14 states that expanded Medicaid, including Kentucky, and 11 that did not. Kentucky showed the biggest change because so many people gained coverage, according to the study.

The study’s lead author, Sayeh Nikpay of Vanderbilt University, said the ACA is working and more people are covered. Accessing a primary care physician when needed, though, is another story.

Because health care still isn’t consumer-friendly enough for patients to access doctors after hours or on weekends, some newly insured people needed the emergency room for lack of other options, Nikpay said.

“Some of those people may have wanted to go and visit their primary care physician,” Nikpay said.

While uninsured patients do go to the emergency room when necessary, Nikpay said it is essential that those coming to the emergency room have insurance, for the financial security of themselves and the hospitals.

Since the ACA, Kentucky has been a leader in insuring residents with Medicaid expansion and the state-run exchange, Kynect. In 2013, 24 percent of Kentuckians were uninsured. That number went down to eight percent by 2015.

Eligibility for adults was expanded up to 138 percent of the poverty line. Prior to the expansion, a family of three was only eligible with a household income less than $12,000.

Kate Howard is the managing editor of the Kentucky Center for Investigative Reporting.