MIT Study Proves Medicaid Expansion Increases ER Use (Updated)

A new study released today by the Massachusetts Institute of Technology provides evidence indicating that Medicaid expansion will increase rather than decrease Emergency Room utilization.

CAMBRIDGE, Mass. — Adults who are covered by Medicaid use emergency rooms 40 percent more than those in similar circumstances who do not have health insurance, according to a unique new study, co-authored by an MIT economist, that sheds empirical light on the inner workings of health care in the U.S.

The study takes advantage of Oregon’s recent use of a lottery to assign access to Medicaid, the government-backed health-care plan for low-income Americans, to certain uninsured adults. The research examines emergency room records for roughly 25,000 people over 18 months.

“When you cover the uninsured, emergency room use goes up by a large magnitude,” says Amy Finkelstein, the Ford Professor of Economics at MIT and a principal investigator of the study, along with Katherine Baicker, a professor at the Harvard School of Public Health.

The study, which is being published today in the journal Science, also documents that having Medicaid consistently increases visits to the emergency room across a range of demographic groups, types of visits, and medical conditions, including types of conditions that may be most readily treatable in primary-care situations.

“In no case were we able to find any subpopulations, or type of conditions, for which Medicaid caused a significant decrease in emergency department use,” Finkelstein adds. “Although one always needs to be careful generalizing to other settings, these results suggest that other Medicaid expansions are unlikely to decrease emergency room use.”


I can’t wait to see how Obamacare supporters try to explain this one.


Well, that didn’t take long. New York Times jumped on that one like the proverbial duck on a June bug.  Here are the explanations they provide to show why this study really isn’t that important.

1) The time frame for the study (18 months) was too short.

2) ER spending only accounts for 4% of total health care spending.

3) Old habits are hard to break.

4) It takes TIIIIMMMMEEEE to find a primary care doctor.

 One of the factors that can often play into increased utilization of the ER for Medicaid patients is lack of access to primary care physician.  However, this was eliminated as a factor in the Oregon study because the patients included in the study had access to a primary care physician prior to the time they became a Medicaid beneficiary.  And although on an average ER spending accounts for only 4% of total health care spending, for those in lower income brackets, ER spending is at much higher level…as in a 40% increase in ER utilization over 18 months.

By comparison, the researchers involved in the study brought up two significant points that I daresay Liberals would like to ignore.  The first is a phenomenon that Conservative have often lamented, i.e when services get less expensive, as in “free”, people use them more.  The second point was namely this….

Dr. Chandra, who helped conduct another analysis of emergency department use in Massachusetts after the overhaul, called the Oregon study, with its strong design and clear result, “breathtaking.” In contrast, the data from Massachusetts on the association between the insurance expansion and emergency department use was “all over the place,” he said.

“You would conclude what you wanted to conclude depending on which side of political aisle you were on,” he said, adding, “Now we have an answer.”

Yes, now we have an answer.  It isn’t the answer Liberals want, so they’ll deny the validity of the answer until they are blue in the face.  But it an answer all the same.