Choosing the High Cost Option

In a study of the Oregon lottery Medicaid program the authors noted in Science that the Medicaid recipients as compared to others used the ER at a dramatically higher rate. They conclude:

These limitations to generalizability notwithstanding, our study is able to make use of a randomized design that is rarely available in the evaluation of social insurance programs to estimate the causal effects of Medicaid on emergency department care. We find that expanding Medicaid coverage increases emergency department use across a broad range of visit types, including visits that may be most readily treatable in other outpatient settings. These findings speak to one cost of expanding Medicaid, as well as its net effect on the efficiency of care delivered, and may thus be a useful input for informed decision-making balancing the costs and benefits of expanding Medicaid.

Namely those with Medicaid did not, as expected, find physicians to deal with their ailments, but just fell back into the old pattern of the ER but now at a substantially higher rate. This does not bode well to the ACA cost controls. In fact nothing seems to be helping! Told you all so!