Long ER waits at University of Chicago not surprising in the wake of ACA
There should be little doubt that these access problems will be exacerbated as the state has essentially handed out 500,000 Medicaid cards without providing any additional capacity for patient care.
With its hospitals plagued by long wait times, the University of Chicago is proposing to upgrade and expand its ability to handle emergency cases. Longer wait times are not only inconvenient to patients, they have also been linked to poor health-care outcomes when compared to shorter ER wait times.
While the university was already facing long wait times prior to the implementation of the Affordable Care Act, or ACA, the president’s signature law may be compounding the problem. As part of the ACA, states could choose to expand Medicaid eligibility to those earning up to 138 percent of the federal poverty level. The program is the nation’s largest indigent health-care program and is run by the state, but jointly funded by the federal and state governments.
There should be little doubt that these access problems will be exacerbated as the state has essentially handed out 500,000 Medicaid cards without providing any additional capacity for patient care.
Previous work from the Illinois Policy Institute has detailed why the Medicaid program would further increase demand on emergency departments – not reduce it as promised. A recent landmark Medicaid study explains why.
Known as the Oregon Health Insurance Experiment, this study is the only randomized controlled study of the Medicaid program ever conducted. In academic terms, this study is the gold standard. The Oregon study found that ER use by the Medicaid patients increased by 40 percent more than the uninsured control group.
Not only were the increased visits to treat nonemergency ailments or conditions that could have been prevented with primary care, but the increase in visits occurred during both normal and after-hours.
These study results showed that “free” care in the Medicaid program resulted in significantly higher use across the board but did little to improve health outcomes.
That is why Illinois lawmakers should examine approaches such as sliding-scale premium assistance, where nonelderly and nondisabled patients can purchase health insurance based on price to best meet their own individual needs and preferences, as well as control their health savings account. Those who were willing and able could also supplement their coverage plans using their own resources.
The ACA was passed, and Medicaid was expanded, with the promise of reducing ER visits. But the opposite may be happening.
Across the country, there is mounting evidence that ERs are seeing increasing numbers of patients as a result of the ACA and Medicaid expansion. The growing problem of wait times at hospital ERs, such as the University of Chicago, could be a harbinger of similar problems patients may face when attempting to access care. The growing demand on ER departments should remind lawmakers that Illinoisans need access to care – and not merely a Medicaid card.