re: ACA Improved Care and Health Among Low-Income Adults

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a $337 reduction in annual out-of-pocket spending

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ACA Improved Care and Health Among Low-Income Adults by BamaAtl

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This is a lie and you -should- know better

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You are already paying. My bad.

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So basically what they are saying is I should pay more in insurance even though I have not been to the doctor in 2 years because it helps people who choose not to work?



You're gonna pay anyway. They'll be on Medicaid or Medicare.

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What's so funny is that you guys are blabbing about your personal and completely misinformed views.

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Increased Emergency Department Use in Illinois After Implementation of the Patient Protection and Affordable Care Act
Scott M. Dresden, MD, MS*; Emilie S. Powell, MD, MS; Raymond Kang, MA; Megan McHugh, PhD; Andrew J. Cooper, MPH;
Joe Feinglass, PhD

Study objective: We examine emergency department (ED) use and hospitalizations through the ED after Patient Protection and Affordable Care Act (ACA) health insurance expansion in Illinois, a Medicaid expansion state.

Methods: Using statewide hospital administrative data from 2011 through 2015 from 201 nonfederal Illinois hospitals for patients aged 18 to 64 years, mean monthly ED visits were compared before and after ACA implementation by disposition from the ED and primary payer. Visit data were combined with 2010 to 2014 census insurance estimates to compute payer-specific ED visit rates. Interrupted time-series analyses tested changes in ED visit rates and ED hospitalization rates by insurance type after ACA implementation.

Results: Average monthly ED visit volume increased by 14,080 visits (95% confidence interval [CI] 4,670 to 23,489), a 5.7% increase, after ACA implementation. Changes by payer were as follows: uninsured decreased by 24,158 (95% CI
27,037 to
21,279), Medicaid increased by 28,746 (95% CI 23,945 to 33,546), and private insurance increased by 9,966 (95% 6,241 to 13,690). The total monthly ED visit rate increased by 1.8 visits per 1,000 residents (95% CI 0.6 to 3.0). The monthly ED visit rate decreased by 8.7 visit per 1,000 uninsured residents (95% CI
11.1 to
6.3) and increased by 10.2 visit per 1,000 Medicaid beneficiaries (95% CI 4.4 to 16.1) and 1.3 visits per 1,000 privately insured residents (95% CI 0.6 to 1.9). After adjusting for baseline trends and season, these changes remained statistically significant. The total number of hospitalizations through the ED was unchanged.

Conclusion: ED visits by adults aged 18 to 64 years in Illinois increased after ACA health insurance expansion. The increase in total ED visits was driven by an increase in visits resulting in discharge from the ED. A large post-ACA increase in Medicaid visits and a modest increase in privately insured visits outpaced a large reduction in ED visits by uninsured patients. These changes are larger than can be explained by population changes alone and are significantly
different from trends in ED use before ACA implementation. [Ann Emerg Med. 2016;-:1-9.]

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Effect of Medicaid Coverage on ED Use — Further Evidence from Oregon’s Experiment
Amy N. Finkelstein, Ph.D., Sarah L. Taubman, Ph.D., Heidi L. Allen, Ph.D., Bill J. Wright, Ph.D., and Katherine Baicker, Ph.D.
N Engl J Med 2016; 375:1505-1507October 20, 2016DOI: 10.1056/NEJMp1609533

The effect of Medicaid coverage on health and the use of health care services is of first-order policy importance, particularly as policymakers consider expansions of public health insurance. Estimating the effects of expanding Medicaid is challenging, however, because Medicaid enrollees and the uninsured differ in many ways that may also affect outcomes of interest. Oregon’s 2008 expansion of Medicaid through random-lottery selection of potential enrollees from a waiting list offers the opportunity to assess Medicaid’s effects with a randomized evaluation that is not contaminated by such confounding factors. In a previous examination of the Oregon Health Insurance Experiment, we found that Medicaid coverage increased health care use across a range of settings, improved financial security, and reduced rates of depression among enrollees, but it produced no detectable changes in several measures of physical health, employment rates, or earnings.1-4

A key finding was that Medicaid increased emergency department (ED) visits by 40% in the first 15 months after people won the lottery.3 This finding was greeted with considerable attention and surprise, given the widespread belief that expanding Medicaid coverage to more uninsured people would encourage the use of primary care and thereby reduce ED use.

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