Southern California Emergency Room Use Has Actually Risen after the Passage of Obamacare. Here’s Why

By Abram, Susan; Wheeler, Ian | Pasadena Star-News, June 12, 2018 | Go to article overview

Southern California Emergency Room Use Has Actually Risen after the Passage of Obamacare. Here’s Why


Abram, Susan, Wheeler, Ian, Pasadena Star-News


First in a four-part series that examines emergency room use in Southern California.

Homeless people and a growing number of newly insured young adults are flooding Southern California’s emergency departments for non-life threatening illnesses, years after proponents of the Affordable Care Act promised that better health coverage would divert people away from ERs, according state data and public health experts.

State data show the opposite has happened: Emergency department visits, including those that resulted in hospital admissions, grew an average 4 percent every year from 2010 to 2016.

The rise in emergency department use persists more than three years after the main provision of the Affordable Care Act kicked in, at a pace more than five times the average year-to-year population gains of Greater Los Angeles.

California emergency rooms this decade saw a sustained growth in visitors pre- and post-Affordable Care Act. Visits from 1997 to 2006 hovered around 9 and 10 million. By 2010, there were 11.6 million, and by 2016 there were 14.6 million

A growth in homelessness, a newfound comfort among the previously uninsured and a widespread lack of access to ER alternatives such as primary care physicians are among the reasons why.

Hospitals from the northernmost edges of Los Angeles County down to the San Diego County line have seen massive shifts as more prospective patients gained medical insurance: Private or member-only hospitals such as Kaiser began to see more patients with Medi-Cal, while public hospitals such San Bernardino County’s Arrowhead Regional Medical Center lost patients and have reported fewer people in their emergency departments.

A Southern California News Group analysis of data from the state’s Office of Statewide Planning and Development found, from 2010 to 2016:

* Visits to the Southern California’s emergency departments swelled 27 percent, reaching 6.5 million in 2016. It’s as if 1 of every 3 people in the region visited an emergency room that year. Southern California’s population grew just 5 percent in that time, so more people only accounts for part of the trend.

* Medi-Cal recipients grew from one-quarter to nearly half of emergency room users in Southern California, including Los Angeles, Orange, Riverside and San Bernardino counties.

* As the share of patients with Medi-Cal rose, uninsured ER visitors fell from 18 to 8 percent; visitors with private coverage slipped from 32 to 26 percent.

* Despite the jump in visits and admissions, Southern California’s ER average wait times — minutes people spend in an emergency department before they’re seen by a health care professional — appeared to improve slightly in 2016 since 2013, just before the ACA went into full effect.

* Raw counts of both ER visits and admissions rose, but the portion of visitors who ended up staying in a hospital bed dipped from 18 to 14 percent, indicating more patients who were simply treated and released.

* The high number of homeless people with mental health needs who also were enrolled into Medi-Cal has risen sharply, and is most noticeable in California. At the same time, a shortage of psychiatric beds, and mental and behavioral health specialists in California has contributed to the rush to the ERs. The Golden State shows the lowest ratios of specialists, especially in the Inland Empire and San Joaquin Valley, according to California’s Current and Future Behavioral Health Workforce, a report from the University of California, San Francisco.

Those who have been opposed to the Affordable Care Act may say the data prove the system is failing, that these trends hurt patients, cost taxpayers too much and place even more stress on emergency departments and physicians.

But health policy experts and various organizations say that the system, given time, will even out — unless the Trump Administration’s threats to fully dismantle the ACA come to fruition. …

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