Health Policy

April 17, 2017

In emergencies, insurance matters

Medicaid expansion under the Affordable Care Act provides patients with a greater choice of hospital facilities, Vanderbilt researchers have found.

Under the Affordable Care Act, beginning in 2014 states were to extend Medicaid eligibility to people earning less than 138 percent of the federal poverty level, but 19 states (including Tennessee) have declined.

To examine the effect of Medicaid expansion on emergency department access, John Graves, Ph.D., and colleagues used data from 126 for-profit hospitals. Their report appears in the Annals of Internal Medicine.

In states that expanded their Medicaid rolls, among beneficiaries the average travel time for emergency treatment decreased in 2014 by an estimated 6.2 percent, or a little less than one minute. Non-expansion states saw no change in travel time for beneficiaries.

If the time-saving was due entirely to the expansion, it implies a travel time reduction of 24 percent (three minutes) for the new beneficiaries, the authors note.

In Medicaid expansion states, uninsured ED visits in 2014 decreased an estimated 47.1 percent, while in non-expansion states the decrease was an estimated 5.3 percent.

This research was supported by the Robert Wood Johnson Foundation.

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