BUFFALO, N.Y. – Reports that people newly insured through
Medicaid in Oregon made more emergency room visits than the
uninsured may reflect regional issues, says Nancy Nielsen, MD,
senior associate dean for health policy at the University at
Buffalo School of Medicine and Biomedical Sciences and past
president of the American Medical Association.
While the recent studies based in Oregon found that the newly
insured made more emergency room visits than those without
insurance, Nielsen says that Massachusetts did not see a rise in
emergency room use after instituting its statewide health insurance
“It remains to be seen where increases in services will
occur, and it may be different in different regions,” says
Nielsen. “The issue is more complex than obtaining insurance
for the first time, although we know that alone results in people
seeking medical services. For example, if there is ready access to
primary care, those will be the services that are sought by the
newly insured who aren't acutely ill.
“If there is a shortage of available primary care or
specific specialty areas in a region, then indeed the emergency
department of hospitals may initially show an influx of patients.
Hopefully those folks can then be linked with more appropriate
settings for follow-up care.”
Nielsen has served as senior advisor at the Center for Medicare
and Medicaid Innovation (CMMI) in the Centers for Medicare and
Medicaid Services, U.S. Department of Health and Human
She notes that it is instructive to look at the behavior of
uninsured people who are aging into Medicare; for example, a
“It’s well known that these people will typically
delay seeking health services until Medicare coverage begins, and
then there is an increase in services received for the first year
afterward,” she says. “After that, the demand for
health services returns to a more normal level. That would predict
a similar initial uptick in demand from those newly insured under
Obamacare, with a return to more typical levels fairly soon
She adds that several other factors should be taken into account
when assessing the Affordable Care Act.
“Prior to the implementation of Obamacare, acutely ill
people without insurance got hospital care that all the rest of us
paid for,” Nielsen says. “Now there will be a
third-party payer, which takes the burden from hospitals for
uncompensated care and from everyone else who paid higher premiums
to cover care rendered to the uninsured.”
She adds that for those who obtain private insurance through
state or federal exchanges, there are hefty co-pays, especially for
emergency rooms, for the plans that have lower monthly
“Those hefty co-pays will cause people to pause before
going to a higher cost site like a hospital emergency room unless
it's really necessary,” Nielsen says.
She adds that it also isn’t yet known as to what
proportion of the newly insured have chronic conditions.
“Once that becomes clear in about six months (since
insurance has to be obtained by March to avoid the tax penalty), we
can better evaluate the pressure points in a region's health care
service network,” she says.
“But the real news is what has been shown over and over
again: lacking health insurance is hazardous to your health, so the
2.1 million newly insured Americans are in a much better place now,
despite problems that will surely arise, than they were before Jan.