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January 11, 2014

Obamacare surprise: More Medicaid means more trips to the ER

Editor's note: CNHI newspapers that are not weekly subscribers to Taylor Armerding's column may publish this one if they notify him at t.armerding@verizon.net.

The latest “surprise” in the world of Obamacare is that people do not always behave logically.

That should be obvious. But apparently it is not to experts and political leaders who have championed the expansion of Medicaid to cover adults with earnings less than 133 percent of the federal poverty line.

Turns out the promise that it would save money because those people would stop using emergency rooms in favor of doctors’ offices is, like so much in the new law, illusory. Those people don’t use the ER less, they use it more.

The Medicaid expansion was supposed to be mandatory under the new health care law, until the courts rejected it, leaving the decision up to the states. Since then 25 states and the District of Columbia have signed on, with Indiana and Pennsylvania planning to do so, seduced in part by a promise that the feds will pay for the first three years of it, and 90 percent from then on.

But the other sales pitch has been that if poor people are covered by Medicaid, they will no longer get most of their care at emergency rooms, where it is more expensive and where they are likely to have more severe problems that might have been addressed more easily and inexpensively if they had insurance coverage.

Health and Human Services Secretary Kathleen Sebelius used that line during the debate over Obamacare in 2009.

“Our health care system has forced too many uninsured Americans to depend on the emergency room for the care they need,” she said in a statement. “We cannot wait for reform that gives all Americans the high-quality, affordable care they need and helps prevent illnesses from turning into emergencies.”

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