Study finds Affordable Care Act led to fewer emergency department visits by uninsured patients

A study led by a researcher from the Texas A&M University School of Public Health has found that the Affordable Care Act (ACA) resulted in fewer emergency department (ED) visits by uninsured patients overall and also narrowed the gap between visits by uninsured Black and White ED patients.

The ACA, which was passed in 2010, expanded access to Medicaid and reduced the cost of health insurance and of health care in general. Benjamin Ukert, PhD, an assistant professor in the Department of Health Policy and Management, and a colleague from the University of Alabama at Birmingham were the first to assess the ACA’s impact on racial and ethnic disparities in ED use by uninsured patients.

“Racial and ethnic disparities in health insurance coverage are long-standing issues throughout the nation’s health care system and lead to less access to health care and worse health outcomes for minorities,” Ukert said.

The researchers used data on four states from the Healthcare Cost and Utilization Project (HCUP) State Emergency Department Databases (SEDD). The SEDD tracks emergency visits at hospital-owned EDs that do not result in hospitalization, and HCUP uses this data to help policymakers at the community, state and national levels. The states were Georgia, Florida, Massachusetts and New York, which are home to about 20 percent of the nation’s population. Massachusetts and New York expanded Medicaid access and Georgia and Florida did not.

The data covered three years before the ACA’s insurance expansions (2011–2013) and four years after (2014–2017). Patients studied were non-Hispanic White, non-Hispanic Black, and Hispanic adults between the ages of 18 and 64 who visited EDs but were not hospitalized. Regression analyses to identify the effect of the ACA and the separate effect of the Medicaid expansion were used comparing uninsured ED visits by race and ethnicity groups before and after ACA adoption.

The researchers found that the ACA was associated with an overall 14 percent reduction in the rate of uninsured ED visits per 100,000 population. In addition, the disparity between non-Hispanic Blacks and non-Hispanic Whites decreased by 12.4 percent. The study found no decline in disparities in Hispanic compared to White uninsured ED visit rates, even in Medicaid expansion states.

“Our results—fewer uninsured ED visits and reduction of the Black-White ED disparity—were driven mainly by the Medicaid expansion, which expanded access to care for treatable and preventable conditions and thus reduced the number of non-emergency ED visits in those states,” Ukert said.

Despite these gains, Ukert said that Black and Hispanic adults remain more likely to be uninsured than their White counterparts and also have more ED visits.

“The uninsured continue to use emergency departments as their first point of access to health care, and this and other disparities are more common in states that have not expanded Medicaid,” he said. “More policy is needed if the remaining gaps for minority groups are to be narrowed further.”