- The Washington Times - Thursday, January 2, 2014

By urging states to expand Medicaid, Obamacare may actually increase the number of people who will get medical care from emergency rooms, according to a new report Thursday that counters previous Obama administration claims that the Affordable Care Act would stem the need for emergency visits.

Meanwhile, as the new year dawned and the health law’s individual mandate takes effect, the administration argued Americans now have more health options — even as new polling shows consumers continue to struggle with the online sign-up system.

The Medicaid study, published Thursday in the journal Science, says Oregonians who obtained Medicaid benefits in a 2008 lottery used emergency rooms at a 40 percent higher rate than did people who remained uninsured.
The spike in visits involved a variety of medical conditions, including ones that could have been treated in a primary care setting.

“All else equal, basic economic theory suggests that by reducing the out-of-pocket cost of a visit that an uninsured person would face, Medicaid coverage should increase use of the emergency department,” wrote the study’s lead authors, Katherine Baicker of the Harvard School of Public Health and Amy Finkelstein of MIT. “It is also possible that Medicaid coverage may increase real or perceived access to emergency department care.”

The study’s publication comes at a crucial time for President Obama’s health care law, as half the states expand their Medicaid programs under Obamacare to those making up to 138 percent of the federal poverty level. The expansion, which the Supreme Court made optional, took effect in those states on Wednesday.

The Obama administration hoped that through its health overhaul, people who were covered by Medicaid or subsidized private-insurance plans would have primary-care doctors and thus would have greater access to preventive health care, reducing the need for expensive emergency room visits.

The new findings may not affect Obamacare supporters’ plea to expand Medicaid in more states from a moral perspective, but they’re likely to raise concerns about its fiscal impact, a point Mr. Obama repeatedly made trying to sell his health-care plan politically.

Many Republican-led states already were leery of the expansion’s costs.

The federal government only will pay the full tab for newly eligible people from 2014-2016 but then scale back its contribution to 90 percent by 2020.

“This is an important study which confirms that there is no free lunch when you expand insurance coverage — if we are going to cover more folks with insurance, it is going to raise medical spending,” said Jon Gruber, an MIT professor who helped craft health reforms in Massachusetts before aiding the Obama administration with its nationwide model.

White House deputy senior adviser David Simas said Thursday that extending the benefits to more people “is the right thing to do.”

“We expect that more and more states are going to be doing this going forward,” he said during a conference call.

Mr. Gruber, of MIT, said the real question is how much that medical spending increases each year under the health care law.

He said the rate of increase has slowed, significantly, under the law, “so this is a tiny price to pay for covering 30 million Americans with health insurance, improving financial security and health for a huge share of the American public.”

The Oregon study tracked people in the Portland area who were entered into the lottery. Some were selected to gain Medicaid coverage and some weren’t, giving researchers a way to compare ER use patterns. The researchers did say that other studies showed that after Massachusetts enacted its own health reforms in 2006, ER use went down or remained unchanged.

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