Turns out, Medicaid expansion study missed new drops in ER use

What happened in Oregon after Medicaid was expanded?

Yesterday I discussed a new study showing that ER use went up in Oregon after Medicaid was expanded. While critics of Medicaid expansion have seized on it, it turns out that similar increases occurred in Massachusetts after Romneycare was created, but then ER use declined. The same is now happening in Oregon.

As Sarah Kliff reports:

The Science study looks at a 2008 expansion. A lot has changed in the past five years. In fact, over the past two years, Oregon has actually seen a decline in Medicaid emergency department visits this past year — and attributes that to big changes the state has made to how it delivers care to Medicaid patients.

“That study was looking at the old system and the old way of doing things,” says Sean Kolmer, deputy chief of policy and programs for the Oregon Health Authority, which runs the state Medicaid program. “It reflects what we knew would happen. But that’s the old world.”

Here’s a graph (via Kliff) showing what happened:

Changes in ER usage by Medicaid patients in Oregon.

As you see, ER use has not yet fallen below the levels before expansion, but it has declined. And, as my last post discussed, Oregon has made changes in how health care is delivered that is producing changes that reduce costs while also improving people’s health.

Coordinated care organizations (CCOs) are responsible for delivering care within spending caps and one of their efforts revolves around getting patients to use primary care settings rather than ERs.

As Kliff notes:

In year one, the CCOs saw a 9 percent reduction in emergency-department visits among Oregon’s Medicaid population.

Emergency-department spending decreased by 18 percent in Oregon’s Medicaid program, when the 2013 study period was compared to a 2011 benchmark. And, says Kolmer, state health officials’ data show that much of the reduction has come from moving primary care outside the emergency department.

“Most of the things that are being cut are management of chronic conditions,” he says. “It’s things like congestive heart failure and COPD. You shouldn’t see, for example, a kid with asthma going to the ED. That’s completely preventable.”

These later declines in ER use in Oregon show that it really matters how health care is delivered. This really matters for Maine, where I live, and all states.

Perhaps this is a naive hope, but, truly, it should be possible for Maine legislators and the governors to take the real lessons from the Oregon case.

Deciding that a study about Oregon that’s now outdated means that Medicaid shouldn’t be expanded is the wrong lesson.

So what’s the right lesson?

How care is delivered matters, both for people’s health and costs.

You can save lives, improve health, keep people working (and paying taxes) and reduce medical bankruptcies, keep hospitals financially healthy — if you cover more people and do it the right way.

Amy Fried

About Amy Fried

Amy Fried loves Maine's sense of community and the wonderful mix of culture and outdoor recreation. She loves politics in three ways: as an analytical political scientist, a devoted political junkie and a citizen who believes politics matters for people's lives. Fried is Professor of Political Science at the University of Maine. Her views do not reflect those of her employer or any group to which she belongs.