Emergency Rooms as a Measuring Tape

First it was Massachusetts and its stat on emergency room use: E.R. visits declined when the state's universal health insurance initiative fell into place. As more people had access to physicians, they stopped dropping by the emergency room for coughs, colds and sprained ankles.

Now we have the obverse of that report. In 2003, the Oregon Health Plan (a Medicaid expansion program) was forced to cut back on its benefits. Bottom line: Enrollment was cut in half, with 50,000 beneficiaries dropped from the program. Emergency rooms have felt the effect of that cause. A recent study that ran in the Annals of Emergency Medicine found that the restriction of Medicaid eligibility was associated with an increase in emergency-department visits by uninsured patients, without an increase in overall emergency-department volume.

Nothing happens in a vacuum when it comes to Medicaid. "Policymakers contemplating changes to insurance eligibility," the report noted, "need to consider the risk to patients and the clinical and financial burden placed on hospitals and EDs as a result of these decisions."