Medicaid expansion didn't lead to overwhelmed emergency rooms, study finds

After the Affordable Care Act expanded access to Medicaid, some worried that newly insured patients would overwhelm emergency rooms, but those concerns appear unfounded, according to new research from Johns Hopkins Medicine.

The study comes as lawmakers in Washington consider legislation to scale back the federal-state health insurance program for low-income people as part of a larger overhaul of the health care reform known as Obamacare.


"Through the Medicaid expansion, there were some people who believed more patients would choose to go to primary care providers instead of the emergency department, because now they have health coverage, and there were some people who believed that the expansion would swamp the emergency department," said Eili Klein, assistant professor of emergency medicine in Hopkins' School of Medicine. "We wanted to look at what actually happened."

Thirty-two states expanded their Medicaid programs. In a paper published this week in the Annals of Emergency Medicine, Hopkins researchers looked at billing data from Maryland during 18 months before and after enrollment in the health program began in 2014.

Maryland's Medicaid rolls swelled by about 20 percent, or 160,000 people. About 800,0000 already were enrolled in the program.

Overall, the study found there was a 1 percent decrease in emergency room use over the study period despite an increase in the number of insured people.

Those new to Medicaid did use the emergency room more — about 43 percent more than people without insurance, Klein said. But most people don't visit the emergency room much, and the growth in Medicaid enrollees wasn't enough to have much of an effect.

Among those using the emergency room, there was a six percent increase in those with Medicaid coverage and a corresponding decrease in those with no insurance.

Klein said the financial benefits to patients was positive because they weren't stuck with bills they couldn't pay, and the hospitals' bottom lines were protected from uncompensated care.