NCPA - National Center for Policy Analysis

Will Expanding Health Insurance Strain Emergency Rooms?

January 29, 2014

Americans can expect an increase in traffic to emergency rooms as insurance coverage increases, says Raymond Fisman, a professor at Columbia University Business School.

  • Those in favor of universal health coverage frequently cite the use of emergency room care as an example of why Americans need universal health coverage.
  • Health and Human Services Secretary Kathleen Sebelius said that the American health care system "has forced too many uninsured Americans to depend on the emergency room for the care they need."

The idea is that by insuring more people, the newly insured will no longer flood emergency rooms for care. So why would emergency room traffic actually increase with the rise in health care coverage?

  • Fisman bases his conclusions on a new study that examined a health insurance experiment in Portland, Oregon.
  • The state randomly selected residents from a lottery to receive Medicaid coverage.
  • The result? Those selected for Medicaid actually used the emergency room more, rather than less.
  • In fact, emergency room visits increased by 40 percent compared to those that did not receive Medicaid coverage.

Fisman concludes that Portland's experience is likely not unique and that America can expect to see similar increases as more people become insured. Rather than increasing emergency room budgets to accommodate new patients, Fisman suggests finding new ways to deliver health care to low-income populations.

Source: Raymond Fisman, "Straining Emergency Rooms by Expanding Health Insurance," Science Magazine, January 17, 2014. 


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