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Title : Kentuckians on public insurance such as Medicaid used ERs more often after full implementation of the Affordable Care Act
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Kentuckians on public insurance such as Medicaid used ERs more often after full implementation of the Affordable Care Act

Use of emergency rooms was expected to decrease after the implementation of the Patient Protection and Affordable Care Act, but it rose among people with public insurance such as Medicaid, according to a report for the Foundation for a Healthy Kentucky.

One in four Kentuckians in 2015 said they had visited an ER in the past year, about the same proportion as before the ACA was implemented in 2014. The 25.5 percent rate was "significantly higher" than the national rate of 18.3 percent, said the report by the State Health Access Data Assistance Center at the University of Minnesota.

Among people with public insurance, the ER usage rate rose to 41.3 percent from 34.5 percent. Among those with private insurance, it fell to 15.2 percent from 17.4 percent.

Supporters of the law said that as more people became insured, the more likely it would be that they would find a medical home to meet their health-care needs. "One of the benefits supporters hoped would result from the ACA was reduced use of ERs, where treatment is a lot more expensive," Foundation CEO Ben Chandler said in a news release. "What we found is that ER visits declined for several months after the ACA first went into effect, but then they rose again."

The study found that since the implementation of the ACA in 2014, the total number of ER visits dropped during the first three quarters of 2014 and then rose to a level in 2016 that was 4.5 percent higher than in 2012.

The survey asked Kentuckians why they went to the ER. Nearly three in 10 said they went because of a medical emergency. About the same number said they went because no other facilities were open when they needed care. Only 3 percent used the ER because they didn't have a regular doctor; another 3 percent said they used the ER because it was close by. Seven percent said they went because their doctor told them to, and 3 percent said they were taken by an ambulance.

"The explanations are multifaceted, but it turns out Kentuckians had some very rational reasons for heading to the ER," Chandler said. "The bottom line is that many of the benefits of having insurance coverage for the first time in life will take a while to play out, and that's certainly the case with ER use."

For hospitals, the difference is that they are being paid for many ER visits because more patients have insurance. Kentucky has had the largest drop in the number of uninsured in the nation since the ACA, dropping from 20.4 percent in 2013 to 7.8 percent in 2016, according to Gallup.

The study found that the proportion of ER visits that hospitals reported as charity care or self-pay dropped from 23 percent in 2012 to less than 6 percent by the third quarter of 2016. Meanwhile, visits covered by Medicaid rose from almost one-third in 2012 to almost half in 2015 and 2016.

"Hospitals have benefited from the ACA because they're having to eat less of the cost of caring for uninsured Kentuckians," Chandler said. "That's especially important for smaller, rural hospitals."

The report, "Emergency Department Utilization in Kentucky," is part of the foundation's ongoing study of the impact of the ACA in Kentucky.

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