Medicaid Expansion Causes 40 % More Emergency Room Visits

Mar 24, 2014 by


Medicaid Expansion Causes 40 % More Emergency Room Visits


by Henry W. Burke





The Lie:

On 12.15.09, Obama stated:

The final bill [will] make sure that people are getting the care they need and the checkups they need and the screenings they need before they get sick — which will save all of us money and reduce pressures on emergency rooms all across the country.



The Truth:

Startling facts have emerged from the Oregon Health Insurance Experiment.  When Medicaid made health care “free,” these households made 40 % more emergency room visits


The increase in ER usage from Medicaid was solely in outpatient visits.



Obama’s Emergency Room Lies

Obama made a lot of promises to sell Obamacare that have turned out to be false.  Part of that sales effort involved lies about Emergency Room (ER) use.  The following list of lies was assembled by Forbes contributor Michael F. Cannon.



Barack Obama Stated:


           [O]ne of the areas where we can potentially see some saving is a lot of those patients are being seen in the emergency room anyway, and if we are increasing prevention, if we are increasing wellness programs, we’re reducing the amount of emergency room care…



          [T]hose of us with health insurance are also paying a hidden and growing tax for those without it — about $1,000 per year that pays for somebody else’s emergency room and charitable care…If there are affordable options and people still don’t sign up for health insurance, it means we pay for these people’s expensive emergency room visits.



          The final bill [will] make sure that people are getting the care they need and the checkups they need and the screenings they need before they get sick — which will save all of us money and reduce pressures on emergency rooms all across the country.




          You can’t get those savings if those people are still going to the emergency room.




          [P]eople are no longer going to the emergency room and they now have good health care, they’re now getting preventive care.




Medicaid’s Flawed Design


Why does Medicaid perform so poorly and cost over $500 billion per year?  The program has fundamental design flaws.  The authors of the 1965 Medicaid legislation believed it was morally wrong to expect poor people to pay for their own health care.  Accordingly, the law mandates co-pays close to zero for both primary care and emergency room usage.


Because Medicaid is nearly free, the program enrollees abuse the system by seeking inappropriate care.  In order to cut costs, states are paying doctors less and less to provide the same care.  That has led many doctors into refusing to accept new Medicaid patients.  The patients, in turn, may have to wait weeks and make many phone calls to find someone who will treat them.  As a result, many Medicaid patients simply go to the emergency room for their primary care.


Hospitals have a money problem.  Because Medicaid pays hospitals much less than private insurers pay for the same care, many hospitals lose money on every Medicaid patient they see.  Medicaid is a failed model and Obamacare is dumping more patients into the failed program.


As Obama reasoned in his speeches, the uninsured people will delay care until they are so sick that they end up in the emergency room.  When they do not pay their ER bills, hospitals shift the cost to those people with insurance.  The Obamacare proponents try to argue that the health care law will encourage people to seek care sooner and get treatment in less expensive settings.  Supposedly, this leads to health care savings. 


Nationally, we spend about $50 billion a year on uncompensated care for the uninsured.  Obamacare spends $250 billion a year of taxpayer money to cover the uninsured.  It makes no sense to spend $250 billion to address a $50 billion problem!  Only Washington would consider this “savings.”




Oregon Health Insurance Experiment Exposes the Lies


Unfortunately for Obama, the facts do not support his statements and claims.


The Oregon Health Insurance Experiment is the “gold standard” among studies on the effects of health insurance.  It followed 24,646 low-income residents in the Portland, Oregon area over an 18-month period.  The study compared a group of Oregonians who were uninsured (and stayed uninsured) with a group who were enrolled in Medicaid, by virtue of “winning a lottery.”


The study was co-authored by Sarah Taubman of the National Bureau of Economic Research, Heidi Allen of the Columbia School of Social Work, and Bill Wright of Oregon’s Portland Medical Center.  Economists Amy Finkelstein of MIT and Kate Baicker of Harvard published the findings in an article in the 1.02.14 Science Journal.



This “lottery” created a rare opportunity to study the effects of Medicaid coverage.  By using a randomized controlled design, the study provided reliable results.  The twelve hospitals in the study encompassed “nearly half of all inpatient hospital admissions in Oregon.”  There were no statistically significant differences between the two groups in demographic characteristics.


What did the study find?  In the 1.02.14 issue of Forbes, Avik Roy reported:


          The authors found, as they had previously, that the subgroup that had gained coverage under Medicaid showed no improvement in the management of their chronic medical problems, such as high cholesterol, high blood pressure, and diabetes.

          They also found that those on Medicaid used the emergency room 40 percent more than the uninsured did—1.43 ER visits per Medicaid enrollee, as against 1.02 for the uninsured. More to the point, a majority of the emergency room visits were unnecessary, because they involved conditions that could easily have been managed outside of the ER.

Of the 0.41-per-person increase in visits, 0.18 were “primary care treatable,” meaning they didn’t require ER care. 0.12 didn’t even qualify as emergency care. 0.04 did qualify as emergency issues, but could have been prevented by adequate primary care.





The Medicaid group made more use of preventive and primary care services, but ER use rose as well.  When Medicaid made health care “free,” these households made 40 % more emergency room visits.


The increase in ER usage from Medicaid was solely in outpatient visits.


The finding that Medicaid increases emergency room use deals another blow to Obamacare and Medicaid expansion.



General Obamacare Lies


Barack Obama’s lies about Obamacare have been well documented.  The first three lies (about keeping your doctor, keeping your health care plan, and saving $2,500) have greatly damaged his credibility and popularity.   


Obama constantly repeated these promises: 


          If you like your doctor, you can keep your doctor, period. 


          If you like your health care plan, you can keep your health care plan, period.



During the 2008 presidential campaign, Barack Obama declared:


          I will sign a universal health care bill into law by the end of my first term as president that will cover every American and cut the cost of a typical family’s premium by up to $2,500 a year



Even left-leaning organizations can see Obama’s proclivity to tell lies; the fact-checking website PolitiFact awarded Barack Obama the 2013 “Lie of the Year” for his statement “If you like your plan, you can keep it.”


We know these are more of his broken promises.  Under Obamacare, many people will have to change doctors.  Due to Obamacare, health insurance companies are cancelling millions of people from their health care plans; and these people will be forced to find replacement insurance plans, usually at much higher prices.


Many Americans will have to pay double or triple what they were paying before Obamacare.  


Obama’s signature health care plan leaves 26 million Americans without insurance and drives the cost up substantially.  Making this even worse is that the expansion of Medicaid recipients will add to state taxpayers’ woes.



Scorecard of State Medicaid Expansion


Group A — Enlightened States:

The following 21 states have not expanded Medicaid: Alabama, Alaska, Florida, Georgia, Idaho, Indiana, Kansas, Louisiana, Maine, Mississippi, Montana, Nebraska, North Carolina, Oklahoma, South Carolina, South Dakota, Tennessee, Texas, Virginia, Wisconsin, and Wyoming.


Group B — Wavering States:

The following four states are considering Medicaid expansion: Missouri, New Hampshire, Pennsylvania, and Utah.


Group C — Expansion States:

The following 26 states (25 states plus D.C.) have chosen to expand Medicaid: Arizona, Arkansas, California, Colorado, Connecticut, Delaware, District of Columbia, Hawaii, Illinois, Iowa, Kentucky, Maryland, Massachusetts, Michigan, Minnesota, Nevada, New Jersey, New Mexico, New York, North Dakota, Ohio, Oregon, Rhode Island, Vermont, Washington, and West Virginia.





The facts revealed in the Oregon study deflates the argument that expanding Medicaid coverage will lower Emergency Room usage. 


The Oregon Health Insurance Experiment demonstrated that emergency room usage grows under Medicaid expansion.


When “free” health care was offered, ER use increased by 40 percent!  


More importantly, the study calls into question the credibility of the president.  When the ER lies are coupled with the other Obama health care lies, a strong case is built against him.


Can you believe anything that Barack Obama says?





Bio for Henry W. Burke


 Henry Burke is a Civil Engineer  with a B.S.C.E. and M.S.C.E.  He has been a Registered Professional Engineer (P.E.) for 37 years and has worked as a Civil Engineer in construction for over 40 years. 

Mr. Burke had a successful 27-year career with a large construction company. 

Henry Burke serves as a full-time volunteer to oversee various construction projects. He has written numerous articles on education, engineering, construction, politics, taxes, and the economy.


Henry W. Burke


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1 Comment

  1. Avatar

    85% of the people who use the emergency room is the illegals & there families. With 11 to 22 millions, I believe there are a lot more, are low income worker who don’t want anyone to know about them or there families, can go to a emergency room and don’t have to give any proof of citizenship, so they get services and leave the bill for us to pay.

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