Medicaid expansion under ObamaCare will lead to more emergency room visits, study suggests


#1

I know it’s Foxs News, but I have to say, as an Emergency Room nurse, business has been brisk since the beginning of the year. Too brisk. We’ve been drowning in patients and utterly overwhelmed. Throughout December numbers were low.

foxnews.com/politics/2014/01/04/study-suggests-medicaid-expansion-will-lead-to-more-emergency-room-visits-under/


#2

I believe we’re about to see a major demonstration of the Law of Unintended Comsequences.


#3

If a person has medicaid you can refer them to a urgent or walk in care medical office. That is what we do in Oregon.


#4

Maybe all this means is that people finally have the ability to see a doctor for a change.

One of the major problems with all ER’s has been this: Too many people use them for minor injuries, sore throats and what used to be cared for at home or at the doctor’s office. I am old enough to remember my mother fixing my sister’s and brother’s split lib, my brother’s half torn off toe nail, or to hear about my grandmother digging rocks out of my dad’s knees. Today any kid with that kind of an injury hits the ER.

I am all for more “Urgent Care Facilities” where people can go when the kid does rip off a nail, step on glass or gets the horrible flu bug. I have used such facilities for allergic reactions and asthma attacks and the cost is less.


#5

Honestly, the people going to the ER with the Medicaid expansion, more than likely, are people whose main experience with doctors in the past was in the ER. Most of them have only just now gotten covered and are having to wait a while before there is space for them at a primary care physician. Urgent care facilities exist, but many people don’t know the difference between an urgent care facility and an emergency room (or know that urgent care facilities even exist). If anything, this simply highlights the need for more primary care physicians, especially PCPs that take Medicaid.


#6

The study had conflicting results. Self-reporting via survey of the lottery participants showed no increase in ER usage. Subsequent review of hospital emergency department records did show an increase. As I noted in another thread on this topic; this difference is unexplained and it is an important one to reconcile given the prevalence of medicare billing fraud. Aside from that; the data is six years old and only covers the first 18 months after the lottery was conducted. More recent data actually does show a decline in emergency room usage.


#7

As a side note to your comment about medicaid billing fraud. One thing my sister and I have learned since she was granted disability, is that there is no way anyone has an accurate figure to the amount of fraud that is actually occurring. It could be way less or a whole lot worse. The reason: We have been told by the Medicare/Medicaid department that they are on average 10 years behind in their paperwork.

One of the reasons we found this out is they accused my sister of fraud, saying she never paid them money owed. It turns out she owes nothing, and had followed all their reporting requirements concerning funds, stopping and/or increasing benefits. So she is falsely accused of fraud. Our suspicion is that the vast majority of people accused of fraud are not guilty of any such thing. I can also say that very similar things happened with the disabled when I worked with them.

We were always trying to keep up with what the Disability and Medicaid Offices said was real versus what we knew to be true. No one can expect accurate reporting of fraud when the system is that delinquent in getting their own paper work done. We have also found that the average turn over time for those working the “front line” is less than a year. Our own experience has shown most of them don’t have a clue about the actual rules, regulations and changes.

My take on all of this is as follows: individual fraud is much, much less than reported. Not to say it isn’t out there, but the rate is grossly over estimated. As for the internal fraud; actual intentional fraud may be less than realized, but the structure and lack of properly trained staff, consistent staffing and errors or the absolute lack of knowledge results in a lot of mistakes and rehashing of work.

I find no excuse for it. If we are going to actually correct this we need to take a different approach than brushing everything off as deliberate acts of fraud. We also need to hire more people to do the job. As I say, there is plenty of work to be done and jobs to have if those in power would let them be created. To much money goes skyward and not enough is directed were it really needs to go: To those who need a job and are told there are no openings.


#8

They cannot afford to do that. Medicaid patients are a net loss.


#9

Oh brother. Now that is a nice way to refer to a human being for which Medicaid is their only option of care. No one should be classified as a “net loss.” That is part of the problem in this country: The almighty dollar has become our God and dictates how we think. Disgusting.


#10

Yes, it is disgusting. It really shows you how much the government cares, when they aren’t even willing to pay the costs for decent medical care.


#11

Whats stopping you from taking on $100,000+ debt to go to medical school, then opening up your own private practice taking on another $250,000 in debt for up front costs and ongoing expenses for payroll, taxes, insurance, etc.?

Then you can see all the Medicaid patients you want. Bet they’ll drive nicer cars than you do Doc.


#12

Bet they don’t


#13

Bet you are right. So very right.

Usually to qualify for medicaid, say due to disability, the person is allowed to own one car only and it has to be at least 6-7 years old. It can’t be new.


#14

I have, over the years, reviewed thousands of Medicaid patients medical records because of part of my occupation. ER use, often for trivial reasons, is very widespread among them, undoubtedly because it’s free. Around here, a visit to the ER will cost you anywhere from $750 to $1,000 if you actually have to pay for it. Even if you have insurance, the deductibles are high. So people who are not on Medicaid generally avoid ER use if they possibly can.

I read that in France, “government healthcare” is actually a system of reimbursement. You pay up front, then request reimbursement from the government. One exception, for years, was ER care. That was billed directly to the government. But it got so overutilized that the French changed that.


#15

Maybe. I guess the Obamacare signups who don’t qualify for the insurance exchages are put on Medicaid, and there are lots of them. I’m not sure of it, but I don’t think that segment is means tested other than as regards income.

I have to say it, even though it’s irrelevant. Some things depend on where you live. Around here the joke is: “Question: How can you tell an Ozark millionaire from a factory worker? Answer: The factory worker’s pickup is newer, but the millionaire has a better rifle in the back window.” Lots of truth to that, at least in this neck of the woods. :wink:


#16

Medicaid is NOT the only option and there was a very extensive study in Oregon that determined patients with NO insurance received as good or better care than Medicaid patients.

When Geist means Medicaid patients are a ‘net loss’ it refers the the massive amount of regulation, paperwork and delays in being paid. It’s not the PATIENT it’s that taking Medicaid patients is not only poor paying (we get about 10 to 15cents on the dollar and our fees haven’t increased since the 1980s) but Medicaid ties a doctor’s hands. For example a doctor cannot give free care or free medications to patients on Medicaid because of the fraud regulations.

Medicaid is a very broken system and is frankly cruel to the poor. Read Avik Roy’s book on why Medicaid is terrible for the poor. He details the story of a child who basically died of a toothache. His mother couldn’t find anyone to take him for so long that the abscess went into his brain and he died. Had he been without insurance he may well have been taken to a low income or free clinic.

Medicaid handcuffs doctors and provides really a poor standard of care. And Obamacare EXPANDS this wonder while simultaneously claiming all of the individual plans that were cancelled were “junk plans.” Believe me, patients are better off with these plans than Medicaid.

Lisa


#17

A doctor in a private practice seeing too many Medicaid patients will be lucky to afford bread.

The irony is he will have to pay for his own medical insurance too.


#18

We ended up closing our pediatric surgery clinic because over the years the patient mix became about 70% Medicaid. We couldn’t pay our rent, we couldn’t pay our clinical staff, we couldn’t pay our malpractice. Just an example, one of the most common heart surgeries for a baby had a “price” of $5,000. Now this is heart surgery on a 5 or 6 lb infant whose heart is the size of a walnut. The surgery lasted several hours and of course there was pre and post operative care. Along with the lead surgeon, there was always an assistant surgeon. For this we received the princely sum of $700 from Medicaid! On an hourly basis we realized we made less than the guy who came in to fix the copy machine!
We gave up a few years ago and closed the clinic.

We had another practice in a lower income area of California with about 30% Medicaid/60% Medicare, both very low paying. That too was impossible to maintain.

The expansion of Medicaid might result in more people having little cards to put in their wallets but it’s not going to get them into see a doctor. As the article noted, why wait when you can march into the ER and demand free care? Do we think the usage will drop?

Lisa


#19

To my knowledge there is no one that does not qualify for the Obamacare. However, if your income is low enough you will be directed to file for Medicare/Medicaid or will qualify for government subsidy to help you pay for the provider of your choice. (That will be coming from Medicare


#20

This matches my own experiences in dealing with practices that see Medicaid patients…which I no longer do because getting paid by them was a nightmare. I only work for acute care hospitals for the last several years.


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