NCPA - National Center for Policy Analysis


July 13, 2010

The new health reform legislation will cause emergency room (ER) visits to soar, predicts John C. Goodman, President, CEO and the Kellye Wright Fellow with the National Center for Policy Analysis (NCPA). 

According to an NCPA Brief Analysis: 

  • The use of the emergency room by uninsured patients is not that much different than usage by the insured.
  • The heaviest users of the ER (in proportion to their numbers) are Medicaid patients, probably because Medicaid reimbursement rates are so low that physicians are not anxious to see them.
  • And the reason why that is important is that more than half of the people who gain insurance under the new health reform bill will enroll in Medicaid.  

At this point, any attempt to predict what will happen is very speculative.  Yet a few back-of-the-envelope calculations convince us that there is reason for concern, says Goodman. 

Suppose that 1) half the uninsured obtain insurance; 2) the newly insured enroll 50/50 in Medicaid and private plans; 3) the newly insured are representative of the uninsured population in terms of emergency room use while they were uninsured; and 4) the newly insured behave in a way similar to other enrollees in the plans they join.  Under these assumptions: 

  • Among the newly insured under age 18, the number going to the emergency room each year will climb from 18 percent to 22 percent.
  • Among those ages 18 to 44, annual emergency room traffic by the newly insured will increase from 21 percent to 28 percent.
  • Among those ages 45 to 64, the increase will be from 19 percent to 28 percent.  

In terms of the actual number of visits, insuring between 32 million and 34 million additional people will generate between 848,000 and 901,000 additional emergency room visits every year, says Goodman. 

In general, people with insurance consume twice as much health care as the uninsured, all other things equal.  The trouble is that the new health insurance law has no provision for increasing the number of health care providers.  As a result, when people try to increase their use of physician services, many will be disappointed and a large number are likely to turn to the emergency room when they cannot get their needs met at doctors' offices, says Goodman. 

Source: John C. Goodman, "What Will Happen To Emergency Room Traffic?" Health Affairs Blog, July 12, 2010. 

For text:  

For NCPA Brief Analysis: 


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