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2 Studies Show ACA Impacting Hospital Visits


Two new studies show how the Affordable Care Act is changing hospital use in the United States. However, the results differ depending on the patient population involved.

Two new studies suggest the Affordable Care Act (ACA) is having a significant impact on the number of patient hospital visits, though the impact differs depending on the patient population.

A new report from the Colorado Health Association (CHA) found Emergency Department (ED) visits jumped 5.6% in Medicaid expansion states in the second quarter of 2014 versus the second quarter of 2013. Non-expansion states saw an increase of only 1.8% over the same time frame.

“These findings confirm that individuals who previously had no insurance coverage are now seeking and receiving health care services — and their needs are great,” said Steven J. Summer, CHA’s president and CEO.

Meanwhile, a separate report, conducted by Stanford University researchers and appearing in the September edition of Health Affairs, found the ACA appears to have lowered the number of ED visits for young adults. The study used 2011 data from 3 states — California, Florida and New York – and tracked ED visits for 2 cohorts of young adults: those ages 19-25 and those ages 26-31.

The younger group saw a decrease of 2.7 ED visits per 1,000 people. The older group (the control group) saw a reduction of 2.1 visits per 1,000 people. The largest drops were among women (down 3%) and blacks (down 3.4%). Altogether, the researchers extrapolate that American hospitals saw 60,000 fewer ED visits by young adults in 2011 as a result of the legislation.

However, the data doesn’t necessarily mean fewer individuals are making ED visits. When the researchers factored in the probability of a given person ever having visited the ED, the numbers suggested “that the change in the number of visits was driven by fewer visits among ED users, not by changes in the number of people who ever visited the ED.”

The CHA study also found Medicaid patients are becoming a much larger proportion of the patients hospitals see. The proportion of Medicaid charges in hospitals in expansion states hit 19.1% last quarter, up from 15.1% in the second quarter of 2013. Non-expansion states saw an increase of just half a percentage point, to 13.6%, during that same period.

Taken together, the reports suggest that patients are benefitting from expanded health insurance coverage.

“The true measure of success is finally knowing whether the people who need healthcare are actually receiving it,” said Chris Tholen, vice president for financial policy at CHA. “An insured community is a healthier community.”

Still, a looming question for hospitals and other healthcare providers is what the net fiscal impact of these ACA-inspired trends will be.

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