New Oregon Data: Expanding Medicaid Increases Usage Of Emergency Rooms, Undermining Central Rationale For Obamacare


Another of the “facts” used to argue for Obamacare turns out to be wrong. Who would have guessed that? People who do not pay for services have no incentive to use those services wisely. DUH!

Quote from the article:

"Only in Washington is spending $250 billion to address a $50 billion problem considered “savings.”


Not that I need to point out how biased this article is, as it is readily apparent, but that $50 billion figure only includes inpatient procedures and services. It does not include outpatient procedures and services which are used far more frequently. Additionally, this isn’t just about immediate savings; its about long term savings. The cost of both inpatient and outpatient procedures and services in addition to insurance premiums will gradually decline for everyone as more people become insured.


Actually you misread the article. It studied inpatient hospitals (not inpatient services). Outpatient hospitals and surgery centers do not have ERs, and a patient on medicaid can’t just walk in and be seen.

Also Forbes is not a very biased news source. They publish articles that cover the spectrum and try to cover the news. Here they are covering a study (co-authored by people in economics and social work among others).

From the article:

UPDATE: Some more details on the study, for those who are interested. The twelve hospitals in the study encompassed “nearly half of all inpatient hospital admissions in Oregon.” The period observed was approximately 18 months—from March 10, 2008 to September 30, 2009. There were “no statistically significant differences between the groups in demographic characteristics measured at the time of lottery sign-up.” As noted above, the increase in ER usage “from Medicaid is solely in outpatient visits…Medicaid statistically significantly increases visits in all classifications except for the ‘emergent, non-preventable’ category. The increases are most pronounced in those classified as ‘primary care treatable.’”


What are you talking about? You can walk into ANY hospital ER with a sniffle and leave in a few hours with a $21 Advil tablet. That constitutes outpatient services and it happens all the time; especially among the uninsured. Costs associated with that are not included in the $50 billion figure. That figure only includes inpatient procedures and services (i.e. those which require short term to extended hospital stays) which are used far less frequently by the uninsured than using an ER for preventative and primary care. So to say that this is merely a $50 billion problem is a gross and deliberate misrepresentation of the issue.


Yes, a hospital with an ER, does both inpatient and outpatient services. The study, as I quoted, specifically looked at all categories, both outpatient and inpatient services (all categories) in order to compare, in 12 inpatient hospitals. (There is a difference between inpatient hospitals and outpatient hospitals/surgery centers, my son had eye surgery at an outpatient hospital, where there was no ER and did not accept patients off the street, you had to be referred and have an appointment).

Again from the article

As noted above, the increase in ER usage “from Medicaid is solely in **outpatient **visits…Medicaid statistically significantly increases visits in all classifications except for the ‘emergent, non-preventable’ category.


I think you may have misunderstood what I was saying. I was pointing out the classification of this as merely a “$50 billion problem” is a misrepresentation because that $50 billion figure does not include the costs associated with outpatient procedures and services.


Not only does the article document this reality, it makes perfect sense. A patient with Medicaid is much more likely to avail himself of the Emergency Room BECAUSE he thinks he has “insurance.” Whether for inpatient care or outpatient care, knowing you won’t have to pay out of pocket creates an incentive to utilize the “free” benefit.

There was also a very extensive study in Oregon demonstrating that patients with Medicaid are no better off, receive no better treatment than patients who are self pay. The irony about the vapid blathering of “improving care” and “getting insurance for the uninsured” is that they are forcing more people onto the WORST third party payer system, Medicaid. And as Obamacare clicks in, fewer doctors will be available to treat more patients resulting in wait times and people not getting quality care.

Amazing how often these grandiose plans result in unintended and detrimental consequences. If the actual objective were to get more patients better medical care the focus would be on how to deliver care efficiently instead of how to create a broken website, moronic ads, and spend a fortune on lawsuits defending this monstrosity.

Patients lose with Obamacare.



I’ve worked as a consultant for outpatient (ER+amb surg) billing and coding services for about 8 years.

I could have told you this would happen.

The ER is a fantastic deal with Medicaid; it’s a centralized center of care and they’re guaranteed to see a PA or doctor and for them it is 100% free.

Many Medicaid patients also take ambulances since they are also 100% free (to them-taxpayers get to pay $300.00 for the ride) whereas if they called a cab they would have to pay ten dollars or so themselves.

Medicaid is a rampant cancer devouring ever more dollars for a reason, it is the penultimate welfare program that only gets bigger and more expensive.

In case you’re wondering the most common diagnoses seen in ER’s are otitis media (ear infection), pharyngitis (sore throat) and sprains. None of these are emergencies but they’re the bulk of the cases I review.

It’s not unusual to see people getting treated for mosquito bites, toothaches, or sunburn either.


Oh and don’t forget we must provide translators and MANY of the folks in the ER are non-English speaking.

You are so right, the well intentioned laws requiring those who enter the ER must be seen and perhaps treated, have created a monster. It would be far more efficient to have funding go to some of the small “Zoom Care” type clinics than support the huge infrastructure of an ER with its high tech equipment and staff.

When people who are not a part of the medical care system create laws and rules and parameters for delivering care, they are creating an expensive and inefficient system that is bad for doctors and other medical providers and also for patients (not to mention taxpayers)

Whose great idea was it to put lawyers in charge :smiley:



The magazine Forbes may not be biased, but the article we are discussing came from a blog on The distinction is important, because the author is head of a politically oriented think tank, and was part of the Romney campaign. The article isn’t a neutral source.

However, the central issue is whether increased Medicaid funding increased use of health care, or whether it increased patients likelihood to use an emergency room instead of less expensive medical providers. The difference is important because simply increasing access to health care (as with increased Medicaid) can be expected to reinforce prior health care seeing patterns. If someone is in the habit of getting their care via an ER, they can be expected to continue that habit. If so, the problem isn’t from increasing access to health care, but is due to not changing people’s perceptions of where to get care.

The author of the article we are discussing does raise a good point, though. Are co-pays necessary to deter needless demands on the health care system? The study doesn’t address this topic, but it is an interesting issue. Arguably, the extensive wait in emergency rooms serves as a deterrent to seeking unnecessary care. However, I think we need to see some studies which examine this question in detail. Weighing co-pay versus non-copay in ER usage might be revealing.


The study did have some interesting findings. The authors did not find an increase in ER visits when gathering this information in the form of a survey of the lottery participants. They did, however, find an increase in ER visits when examining hospital emergency department records. This difference was never explained, but it is an important one to reconcile given the prevalence of Medicare billing fraud in this country. What the study also found is that the lottery participants are more likely to use preventative care and are 25% more likely to pay their medical bills.


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