Changes in emergency department use associated with Medicaid expansion under the Affordable Care Act: A comparison of waiver and traditional expansion states

Abstract

Abstract Objective To determine whether changes in emergency department use associated with Medicaid expansions differed between states undergoing waiver and traditional expansions. Methods Design: This study was a cross‐sectional difference‐in‐difference and event studies of Medicaid Expansion among states that expanded during or after 2014. Setting: We used a nationally representative cross‐sectional survey from all 50 United States and the District of Columbia from 2010 to 2016. Participants: Adults aged 19–65 years with incomes <138% of the federal poverty level were included. Main Outcomes and Measures: Main outcomes were self‐reported emergency department (ED) utilization in the last 12 months. Results Individuals in states across all expansion types were not more likely to report any ED use in the previous year (2.8 percentage point increase [0.0–5.5], P = 0.052) but were more likely to report visiting an ED 2 times or more in the previous year (2.0 [0.0–4.1], P = 0.049) than those in non‐expansion states. Individuals in states undergoing traditional expansions likewise were not more likely to report any ED use (2.2 [−0.7 to 1.5], P = 0.136) but were more likely to report visiting an ED 2 times or more in the previous year (2.3 [0.1–4.4], P = 0.038). Conversely, individuals in waiver states were more likely to report increase in any ED use (5.6 [0.3–11.0], P = 0.038), but were not more likely to report use of EDs 2 times or more in the previous year (0.8 [−3.2–4.9], P = 0.688). The differences between traditional and waiver states in any ED use and ED use 2 times or more in the previous 12 months were not statistically significant (P = 0.215 and P = 0.501, respectively). Conclusions Three years after expanding Medicaid under the Affordable Care Act, there is little evidence of differences between traditional and waiver expansion states in changes in any ED use or intensive ED use. Future studies should investigate longer term changes in ED use.

Keywords

• Affordable Care Act
• emergency departments
• healthcare delivery
• insurance coverage
• Medicaid