Despite Medicaid expansions in several states as a result of the Patient Protection and Affordable Care Act, encouraging patients to use clinics rather than emergency departments appears like it will take some time, according to a joint report from Kaiser Health News and The Chicago Tribune.
Experts point to studies such as one in Science, which reported previously uninsured low-income adults in the state of Oregon were more likely to visit the ED once they had obtained Medicaid.
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In Chicago, the outlook appears similar. CountyCare, an early version of the Medicaid expansion in Illinois' Cook County, hasn't spurred improvements in emergency roomED volumes. A year into the program, some hospitals have just as many ED patients as before the expansion.
The problem may get worse before it gets better, according to the report, as state officials have estimated about 300,000 people in Illinois will join Medicaid over the next few years. In Cook County alone, CountyCare has already enrolled 76,000 residents in the program, according to county officials.
One of the lingering sources of the capacity problem, according to the report, is that despite the insurance expansion, people use the ED for access to care that is compatible with their schedules. For some, scheduling to see a primary care physician around long hours at work may be impossible. Also, a visit to the ED allows patients to see a clinician more quickly than scheduling a visit with a primary care provider, the wait for which may be as much as one month in some locations.
Indeed, the expanded number of Medicaid patients does not guarantee there will be enough providers who accept Medicaid to go around. Lower Medicaid reimbursements cause some providers to avoid accepting patients on government insurance altogether. A recent analysis from the National Center for Health Statistics found that last year, 8.3 percent of those on public insurance were told a physician's office did not accept it.
While there are no immediate solutions to controlling emergency department capacity issues, the problems remain secondary. "The focus has been on getting people signed up, and the issue of capacity and coordination will follow, hopefully," said David Ansell, MD, CMO and clinical affairs vice president at Chicago's Rush University Medical Center.
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