ACA’s Medicaid Expansion: Not Good for Your Health

This article was featured in our weekly newsletter, the Liberator Online. To receive it in your inbox, sign up here. In 2010, just a few weeks before Congress passed the Affordable Care Act, President Barack Obama said that taxpayers “end up subsidizing the uninsured when they’re forced to go to the emergency room for care…. You can’t get … savings if those people are still going to the emergency room.” Part of what the current administration’s signature health law was supposed to do was to increase cost savings so visits to the ER weren’t as common. After helping to pass the law, then-Speaker of the House of Representatives Nancy Pelosi claimed that “the uninsured will get coverage [so they are] no longer [being] left to the emergency room for medical care.” Six years have passed since those who supported ACA and its main provisions promised to bring the number of ER visits down and yet, a study published in the New England Journal of Medicine shows that assuming ACA would lower the number of ER visits was a mistake. With the expansion of Medicaid in states like Oregon, ER visits increased. But the increase is not the only consequence of Medicaid expansion. When compared to 2015, this year’s Medicaid expansion spending is 49 percent higher per enrollee than what government had expected. In order to expand Medicaid in Oregon, officials used lottery to expand Medicaid benefits to a limited number of lower income, non-disabled adults. According to the study’s authors, “Medicaid’s value to recipients is lower than the government’s costs of the program, and usually substantially below,” perhaps because, researchers found, expanded Medicaid coverage “resulted in significantly more outpatient visits, hospitalizations, prescription medications, and emergency department visits.” When it comes to how Medicaid expansion pushed individuals to the ER, researchers explain that, during the past 15 months, Medicaid increased ER visits by 40 percent. Researchers found that even if patients have Medicaid, there’s “no evidence that Medicaid coverage makes use of the physician’s office and use of ERs substitutes for one another.” What many choose to forget is that Medicaid expansion was made possible because of ACA. And according to the government’s own projections, each Medicaid enrollee cost the taxpayer roughly $6.366 in 2015, 49 percent higher than past predictions. This cost spike is mostly due to the fact the federal government reimburses 100 percent of state spending on enrollees who were added after the expansion was launched. When ACA became law, states were given enough incentives to pay insurance companies high payment rates so new enrollees were cared for, but the high payment rates could only be covered by the federal taxpayer. Since many physicians are leaving the system altogether, preferring to not accept new Medicaid enrollees due to lower rates, patients continued to use ER at a high rate, even higher than years past. So coverage, in this case specifically, did nothing to help patients in need. The result is higher cost to the taxpayer. Instead of making people healthier and helping individuals who are unable to afford medical care, researchers found that the result has been the exact opposite, invalidating ACA apologists. Will they continue to ignore these results?