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Medicaid Expansion Has Helped Patients and Docs in States that Opted In

By Cedric Dark, MD, MPH, FACEP | on February 18, 2020 | 0 Comment
Policy Rx
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The Patient Protection and Affordable Care Act (ACA) has brought about massive changes to the structure of the American health care financing system. As a consequence, an additional 20 million Americans have coverage, and for the first time ever, the uninsured rate dove below 10 percent.1

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ACEP Now: Vol 39 – No 02 – February 2020

For emergency physicians, the ACA has resulted in dramatic shifts in our payer mix, especially among the nonelderly adult population. While the ratios of emergency patients with Medicare have remained relatively stable over the past decade, there has been a slow but steady decline in private coverage. However, in 2013, when the ACA’s Medicaid expansion went into full effect, a dramatic shift in payer mix from uninsured to Medicaid became evident. This has been demonstrated in multiple studies of general emergency department patients, in states such as Illinois and Maryland, for young adults, and for trauma patients.2–9

What does this portend for our specialty? A few years ago, Jon Mark Hirshon, MD, PhD, MPH, FACEP, the current Chair of the ACEP Board, co-authored a paper suggesting that this shift in payer mix from uninsured to Medicaid represented $3.97 additional revenue per RVU for the average emergency physician.10 The calculus for Medicaid expansion is crystal clear. The swath of preexisting data combined with a new paper, presented in this month’s EMRA+PolicyRx Health Policy Journal Club, builds upon what we should agree is an unimpeachable fact.

The ACA positively shifts payer mix for emergency care and ultimately leads to improved financial viability for our specialty. Emergency physicians in the 14 states that have yet to expand Medicaid should strongly consider advocating for the 2.5 million Americans who remain stuck in the Medicaid gap.11,12


Cedric Dark, MD, MPHDr. Dark is assistant professor of emergency medicine at Baylor College of Medicine in Houston and executive editor of PolicyRx.org.

References

  1. Diamond D. Thanks, Obamacare: America’s uninsured rate is below 10% for first time ever. Forbes website. Aug. 12, 2015. Accessed Jan. 17, 2020.
  2. Nikpay S, Freedman S, Levy H, et al. Effect of the Affordable Care Act Medicaid expansion on emergency department visits: evidence from state-level emergency department databases. Ann Emerg Med. 2017;70(2):215-225.e6.
  3. Orgel GS, Weston RA, Ziebell C, et al. Emergency department patient payer status after implementation of the Affordable Care Act: a nationwide analysis using NHAMCS data. Am J Emerg Med. 2019;37(9):1729-1733.
  4. Garthwaite C, Gross T, Notowidigdo M, et al. Insurance expansion and hospital emergency department access: evidence from the Affordable Care Act. Ann Intern Med. 2017;166(3):172-179.
  5. Pines JM, Zocchi M, Moghtaderi A, et al. Medicaid expansion in 2014 did not increase emergency department use but did change insurance payer mix. Health Aff (Millwood). 2016;35(8):1480-1486.
  6. Feinglass J, Cooper AJ, Rydland K, et al. emergency department use across 88 small areas after Affordable Care Act implementation in Illinois. West J Emerg Med. 2017;18(5):811-820.
  7. Klein EY, Levin S, Toerper MF, et al. The effect of Medicaid expansion on utilization in Maryland emergency departments. Ann Emerg Med. 2017;70(5):607-614.e1.
  8. Bush H, Gerber LH, Stepanova M, et al. Impact of healthcare reform on the payer mix among young adult emergency department utilizers across the United States (2005-2015). Medicine (Baltimore). 2018;97(49):e13556.
  9. Knowlton LM, Dehghan MS, Arnow K, et al. The impact of Medicaid expansion on trauma-related emergency department utilization: a national evaluation of policy implications. J Trauma Acute Care Surg. 2020;88(1):59-69.
  10. Pimentel L, Anderson D, Golden B, et al. Impact of health policy changes on emergency medicine in Maryland stratified by socioeconomic status. West J Emerg Med. 2017;18(3):356-365.
  11. Status of state Medicaid expansion decisions: interactive map. Kaiser Family Foundation website. Accessed Jan. 17, 2020.
  12. Garfield R, Orgera K, Damico A. The coverage gap: uninsured poor adults in states that do not expand Medicaid. Kaiser Family Foundation website. Accessed Jan. 17, 2020.

Pages: 1 2 | Single Page

Topics: Affordable Care ActMedicaid ExpansionObamacare

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About the Author

Cedric Dark, MD, MPH, FACEP

A graduate of Morehouse College, Cedric Dark, MD, MPH, FACEP earned his medical degree from New York University School of Medicine. He holds a master’s degree from the Mailman School of Public Health at Columbia University. He completed his residency training at George Washington University where he served as chief resident. Currently, Dr. Dark is an associate professor at the Henry J. N. Taub Department of Emergency Medicine at Baylor College of Medicine. Dr. Dark is the 2017 recipient of the Texas Medical Association’s C. Frank Webber Award, a 2019 American College of Emergency Physicians Choosing Wisely Champion, the Emergency Medicine Residents’ Association 2021 Joseph F. Waeckerle Alumni of the Year Award, one of emergency medicine’s Top 45 Under 45, and on Elemental’s List of 50 Experts to Trust in a Pandemic. He is currently on the Board of Directors for Doctors for America and the medical editor-in-chief for ACEP Now, the official voice of emergency medicine. .

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