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The Affordable Care Act Helped Medicaid Patients in California Avoid the Emergency Room, Study Suggests

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Despite the best efforts of a Republican-led Congress over the past two years, the Affordable Care Act has largely stayed intact. A recent study published in Health Affairs offers the latest bit of evidence that the sweeping health care law, flawed and incomplete as it might be, has been a net good. In California, the study suggests, the ACA’s implementation made some desperate people less likely to turn to the emergency room for medical care.

The researchers, primarily from the University of California San Francisco (UCSF), looked at the medical records of over 14 million non-elderly people who visited an emergency department within the state between 2012 to 2015. Collectively, they accounted for 24.5 million visits. That allowed them to compare visits before and after the ACA’s major provisions went live in 2014, particularly its expanded coverage of low-income residents under Medicaid.


From 2012 to 2013, they found, 6.6 million people visited emergency rooms. Of these, 7.9 percent were people who visited frequently, meaning they visited at least four times within a year. From 2014 to 2015, 7.1 million people went to emergency rooms, and 8.5 percent of patients were frequent visitors. Frequent visitors accounted for 30.7 percent of all ED visits from 2012 to 2013, compared to 31.6 percent of visits from 2014 to 2015.

These raw numbers are somewhat misleading, the authors say. Many uninsured patients, who visited the ER as their main source of medical care because they couldn’t afford a regular doctor, became covered under Medicaid post-ACA. And the researchers found that Medicaid patients as a whole became less likely to use the ER frequently after the ACA went into effect. The smaller percentage of patients still left uninsured also used the ER less often. So though the total number of frequent ER visitors didn’t change, the chances that any individual person on Medicaid or who had no insurance would use the ER frequently did drop.


After accounting for these changes in insurance coverage, they estimated Medicaid patients were 12 percent less likely to have frequent ER visits post-ACA, while uninsured patients were 31 percent less likely.

“Our findings do not necessarily suggest that the ACA caused a decrease in frequent emergency department use among Medicaid and uninsured patients, but rather provides evidence that expanded Medicaid coverage might have allowed these patients to access services for serious health conditions outside of the ED,” said senior author Renee Hsia, a professor of emergency medicine and health policy at UCSF, in a statement.

The findings mirror others that have shown the ACA’s Medicaid expansion—at least in states that have allowed it to happen—has led to better health outcomes, less medical debt, and possibly even helped stall divorce rates.

The percentage of uninsured American adults at the end of 2013 was 18 percent, according to Gallup, and dropped to as low as 10.9 percent just before President Trump took office at the end of 2016. Since then, the rate has slowly crawled back up to 12.2 percent as of the end of 2017.


[Health Affairs]