Will increasing access to health insurance decrease ED utilization by increasing access to primary care providers (PCPs)? On the other hand, does having health insurance make people more likely to visit the emergency department? These questions have important implications for ED capacity, quality of care, and future funding models.
When the Affordable Care Act (ACA) became law, differing opinions emerged about how it might affect ED utilization. Some argued that more insured patients would lead to better access to outpatient care, reducing the need for emergency care, as was seen in Massachusetts following the pre-ACA rollout of their own state’s health insurance expansion (Romneycare).1 Others contended that more access to care would mean more usage of all types of care, resulting in increased ED visits, as 75 percent of emergency physicians believe.2
ED Usage in Illinois
A recent study, an analysis of ED use before and after Affordable Care Act (ACA) implementation in Illinois, provides evidence against the assumption that ED use would decrease as newly-insured patients received care from PCPs instead of the emergency department, leading to more efficient and less costly health care.3 The authors analyzed ED visits across Illinois from 2011 to 2015, comprising 36 months prior to and 24 months following ACA implementation. Although the number of ED visits by uninsured patients dropped, visits by Medicaid and private insurance patients increased more substantially, leading overall to a 5.7 percent increase in ED usage. Meanwhile, visit acuity appeared to remain constant, as the number of hospitalizations through the emergency department was essentially unchanged throughout the study period.