One problem with medicaid expansion so far: ER use is not declining

[Matty]

Note: I am not trying to use this thread to bash medicaid expansion in general (there are benefits and downsides), but rather to try to discuss why it appears that, after 2-3 years of most states expanding it, usage of the ER in place of general practices is not declining.

ER usage has long been viewed as a problem because it costs a lot more, and studies show that busier ERs are associated with negative health outcomes due to wait times, unwillingness to wait, and likelihood of contracting other diseases from others.  Medicaid expansion was, in theory, supposed to be a positive in this area because people that were previously uninsured and using the ER would not be visiting less costly doctor offices instead.

The wapo article is behind a paywall, so I'll link a few more articles on it for you to read

https://www.google.com/url?sa=t&rct=j&q=&esrc=s&source=web&cd=1&cad=rja&uact=8&ved=0ahUKEwiGypWD8_3UAhVqyoMKHd-cBiwQFggmMAA&url=https%3A%2F%2Fwww.washingtonpost.com%2Fnews%2Fwonk%2Fwp%2F2016%2F10%2F19%2Fmore-evidence-expanding-medicaid-increases-emergency-room-visits%2F&usg=AFQjCNEx1t42N-BbQjD5BCVvJq0f3sxfXA


https://www.google.com/url?sa=t&rct=j&q=&esrc=s&source=web&cd=3&cad=rja&uact=8&ved=0ahUKEwiGypWD8_3UAhVqyoMKHd-cBiwQFggvMAI&url=https%3A%2F%2Fwww.forbes.com%2Fsites%2Ftheapothecary%2F2016%2F10%2F20%2Fmedicaid-expansion-causes-surge-in-er-visits%2F&usg=AFQjCNFYY8aWCIxOZQUBs53eOq0kPheh_w

https://www.google.com/url?sa=t&rct=j&q=&esrc=s&source=web&cd=6&cad=rja&uact=8&ved=0ahUKEwiGypWD8_3UAhVqyoMKHd-cBiwQFghBMAU&url=http%3A%2F%2Fwww.modernhealthcare.com%2Farticle%2F20170616%2FNEWS%2F170619908&usg=AFQjCNFOifwVHNb6A4CshtUygCfs013gmA

My question is this: what can we do, policy-wise, do make medicaid patients less likely to use the ER?

A few possible solutions,

1) higher reimbursement rates medicaid pays to physicians and specialists: this will increase the amount of doctors that accept it, which will make it easier for medicaid patients to find a doctor they like, and less likely to resort to ER.

2) increase ER copay that medicaid patients have to pay. A friend of mine is a pharmacist and he posted this on Facebook in a conversation we were having:

You must be logged in to read this quote.

By having patients pay a larger % of the cost of ER care, it would make it less costy, relatively, to visit normal practices instead of the emergency room.

What does this board think we can do about this?

Note: please don't try to think I am coming out against or strictly in favor of m'caid expansion. I want to talk only specifically about the ER usage issue and what we can do about it.