The Tribune Democrat, Johnstown, PA

Editorials

January 11, 2014

Obamacare surprise: More Medicaid means more trips to the ER

(Continued)

No, it won’t. Sadly, as Sebelius, Snyder and President Obama himself are discovering with the rollout of his signature legislation, logic does not prevail in this situation. If they had bothered to do some homework on the issue, they would have known it never has.

Poor people covered by Medicaid still use emergency rooms – more, not less.

Supposedly, this is a surprise. There has been a mini-explosion of stories about a study recently published on the website of the journal Science, which analyzed the use of ERs in Oregon by people newly enrolled in Medicaid. The study found that ER use spiked by 40 percent.

The real surprise ought to be that anybody is surprised. I could have told the Harvard people this before they started the study, because health care professionals were telling me about it back in the 1980s.

They had made the same assumption at first – that if people without health insurance were given access to it, they would no longer have to treat every medical need as an emergency. They would see their doctor regularly enough to manage chronic conditions, and keep minor problems from becoming major ones. And that would “bend the medical cost curve”  – something we heard constantly during the campaign to sell Obamacare.

If only. What they found was a population, in general, that needs more than a health insurance policy. They need someone to function as a surrogate parent – to remind them to do things that the experts had thought they would do on their own.

They found a population that does not plan ahead. They described them as people with “a short time horizon.”

“A lot of them don’t have a steady job, they don’t have a steady place to live, they may have drug or alcohol problems, and about all they can think about is getting through the day. They don’t make appointments. Thinking about next week or next month might as well be 10 years from now,” one hospital executive told me. That was about 30 years ago.

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