Gives people a greater variety of hospital options than they had when they were uninsured, a new study suggests. People often choose hospitals closer to home, the researchers report. The study uses data from two hospital systems that are owned by investors to see if the expansion of Medicaid in 2014 offered under the Act Care Affordable (Affordable Care Act, ACA), often known as Obama care, Affected the use of the emergency department.
The new analysis focused on whether the expansion of insurance altered or not the place where people came for care. He did not observe the amount of care received whether the care was adequate or the quality of care. By expanding Medicaid, it potentially extended access to affordable care to a wider variety of centers said study author John Graves, assistant professor of health policy at Vanderbilt University School of Medicine in Nashville Tennessee.
It seems they are choosing the places to go he said. For example, people are switching from public to private hospitals. Graves said his own practice is located in front of a low-income residential complex. From that residence, you only have to cross the park to go to the nearest for-profit hospital. But the Nashville Public Hospital is located a couple of miles in the city. Uninsured patients use the public hospital without having to worry so much about having to pay outstanding medical bills he said. But if Tennessee had expanded Medicaid under the ACA, more low-income people might be using the closest center, he suggested.
Raven concluded that expanding Medicaid is a good thing for the patient if those hospitals actually offer better quality care or equivalent compared to the centers that are further away. What is somewhat problematic would be if those for-profit hospitals take patients to the public hospitals that depend on their visits Raven said. Public hospitals that primarily care for Medicaid beneficiaries and the uninsured would have to compete with for-profit hospitals, he said.
The study compares changes in visits to the emergency department in states that expanded Medicaid under the ACA versus those that did not. And look at that information before and after the Medicaid extension. Hospital-owned study hospitals operate in six states that expanded Medicaid and in 14 states that did not expand Medicaid as part of the health care reform law. Prior to 2014, the hospital sample had similar trends in emergency department visits, the researchers said.
Twelve months after the Medicaid expansion, emergency departments treating patients in states with enlargement saw a sharp reduction in uninsured visits by 47 percent. There was an even more marked increase in Medicaid visits, nearly 126 percent, the researchers found.
Facts of the phenomenon
Increases in Medicaid visits to private hospitals occurred for all types of consultations, including very serious types of care such as intoxication, hip fractures, and brain hemorrhages, according to the report. Maybe the ambulance drivers are determining where those patients come for care.
And there is evidence that those patients are using hospitals closer to where they live. Times of travel to the emergency department were reduced by three minutes on average, among people who got Medicaid coverage, the study authors said. If Congress insists on repealing the ACA without a replacement, we must restore the safety net cuts to ensure that essential hospitals can continue to care for vulnerable patients and marginalized communities he added.