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Arnold School of Public Health

Study finds reduction in emergency room visits for non-urgent conditions after Medicaid eligibility expansion

September 6, 2022 | Erin Bluvas,

Researchers from the Arnold School’s Department of Health Services Policy and Management (HSPM) have partnered with a colleague at Texas A&M University to examine whether Medicaid eligibility expansion is associated with changes in emergency department visits based on medical urgency. They published their findings in the JAMA Network Open.

As a core component of the U.S. healthcare system, emergency department visits total more than 140 million and incur $75 billion in costs each year. One-third of these visits are considered nonemergent (with many of them even classified as preventable) and therefore treatable in primary care settings. The average cost of these types of visits is many times higher than those that take place in a physician’s office or urgent care center.  

“Although emergency departments treat patients with acute and unexpected healthcare conditions as designed, they often serve as a safety net for individuals who are unable to access other healthcare settings,” says Theodoros Giannouchos, assistant professor of HSPM and lead author on the paper. “Medicaid eligibility was expanded under the Patient Protection and Affordable Care Act, but relatively little is known about how emergency room visits based on medical urgency have changed since the policy went into effect.”

With this study, the researchers aimed to learn more about how the expansion may have impacted emergency department utilization. Using data collected by the Healthcare Cost and Utilization Project State Emergency Department between 2011 and 2017, they looked at more than 80 million visits across four states. This cross-sectional study compared trends between two states that expanded Medicaid (New York, Massachusetts) and two that did not (Florida, Georgia).

The authors found that the states that expanded Medicaid experienced a decrease in emergency department visits compared to the ones that did not expand Medicaid. Further, the decreases were associated with visits for less emergent or nonemergent conditions.

“Limited or lack of insurance coverage is a key factor for many emergency department visits,” says Christina Andrews, HPSM associate professor and co-author on the study. “Uninsured individuals often use the emergency department as a place to receive routine healthcare services and are also more likely to experience a healthcare crisis requiring emergent care owing to the lack of access to outpatient health services and preventive care.”

“The expansion of Medicaid eligibility granted by the ACA presented a unique opportunity to address these challenges by providing millions of U.S. residents with health insurance coverage that could improve access to routine healthcare and preventive services,” Giannouchos says. “Our findings from this study suggest that expanding Medicaid might reduce emergency department visits for conditions that could be treated in outpatient settings.”


Theodoros Giannouchos joins Department of Health Services Policy and Management as assistant professor

Arnold School welcomes Christina Andrews, who specializes in addiction treatment

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