The Conversation

Health Reform Will Not Cut Emergency Room Visits, President Obama Hardest Hit

One of President Obama's constant refrains during the battle over health reform has been that expanding coverage would reduce inefficiency in the system. In particular, he often cited expensive expensive emergency room visits as something that reform could help reduce. But it turns out, Obamacare, like Romneycare before it, is likely to increase emergency visits, maybe substantially.

MIT News reports on a newly published Harvard study of Medicaid users in Oregon:

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.

Emergency room visits are many times more expensive than primary care visits for similar treatment. This is why, both before and after health reform was passed, politicians cited reducing emergency room visits as a reason the law was a good idea.

Wonkblog cites two examples today, Republican Gov. Rick Snyder and HHS Secretary Sebelius who said back in 2009 "Our health care system has forced too many uninsured Americans to depend on the emergency room for the care they need."

But perhaps the person who has made this case more than anyone else is President Obama. He has repeatedly said over the past six years that reform would reduce ER visits thereby creating greater efficiency in the system (i.e. saving us money). Below are 17 examples:

  • Nov 8, 2013 - "You know, one of the reasons to do it is -- I have said this before. Sometimes people don't fully appreciate it. We already pay for the health care of people who don't have health insurance. We just pay for the most expensive version, which is when they go to the emergency room."
  • Oct. 30, 2013 - "we pay more in premiums and taxes when Americans without good insurance visit the emergency room. (Applause.) We get taxed."
  • Oct 1, 2013 - "we should not have a system in which people are regularly going to the emergency room, driving up costs for everybody else, because they haven't acted responsibly."
  • April 30, 2013 - "we would rather have people getting regular checkups than going to the emergency room because they don't have health care -- if -- if we keep that in mind, then we're going to be able to drive down costs, we're going to be able to improve efficiencies in the system"
  • July 17, 2012 - "If you don't have health care, then we're going to help you get it. And the only people who may have a problem with this law are folks who can afford health care but aren't buying it, wait until they get sick and then going to the emergency room and expecting everybody else to pick up the tab.  That's not responsibility."
  • June 28, 1012 - "when uninsured people who can afford coverage get sick, and show up at the emergency room for care, the rest of us end up paying for their care in the form of higher premiums."
  • April 3, 2012 - "we shouldn’t have a system in which millions of people are at risk of bankruptcy because they get sick, or end up waiting until they do get sick, and then go to the emergency room, which involves all of us paying for it."
  • Mar 15, 2010 - "she didn't want to be in a position where, if she did get sick, somebody else would have to pick up the tab; that she'd have to go to the emergency room; that the cost would be shifted onto folks through their higher insurance premiums or hospitals charging higher rates."
  • March 3, 2010 - "taxpayers currently end up subsidizing the uninsured when they're forced to go to the emergency room for care, to the tune of about a thousand bucks per family. You can't get those savings if those people are still going to the emergency room."
  • Feb 2, 2010 - "we want to make sure that everybody has health insurance, which in turn allows us to cut back on some wasteful spending and help upgrade hospitals and doctors and how they perform medicine because now they're not dealing with as many emergency room patients."
  • Dec 9, 2009 - "Today, millions of Americans still have difficulty accessing primary health care, and many of them are uninsured...So they don't get regular checkups, they don't get routine screenings. When they get sick or hurt, they tough it out and hope for the best, and when things get bad enough they head to the emergency room. So we end up treating complications, crises and chronic conditions that could have been prevented in the first place."
  • Sep 17, 2009 - "if there are affordable options and people don’t sign up, then the rest of us pay for somebody else's expensive emergency room care. And that’s not fair."
  • Sep 9, 2009 - "those 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."
  • Aug 14, 2009 - "if we can help provide coverage to people so that they're getting regular primary care and they're not going to the emergency room, we will obtain some savings and that's partly...that's partly how we'll end up paying for giving people health insurance -- because we're already paying for it right now, we just don't notice it."
  • July 22, 2009 - "the average American family is paying thousands of dollars in hidden costs in their insurance premiums to pay for what's called uncompensated care, people who show up at the emergency room because they don't have a primary-care physician."
  • Jun 5, 2008 - Sleep deprived Obama on the campaign trail:
  • Jan 25, 2007 - "They tell us it's too expensive to cover the uninsured, but they don't mention that every time an American without health insurance walks into an emergency room, we pay even more."

Obviously if Obamacare raises the number of emergency room visits by 40 percent, that isn't saving us money. Even if insured visits cost less on average than uninsured visits, it wouldn't still not be a move in the right direction (according to the President).

There were a few people pointing out back in 2010 that this method of cost control was probably illusory. Massachusetts, which served as a model for Obamacare, also saw increased emergency room visits after reform.


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