Obamacare is not popular. In numerous recent polls, such as one from the Kaiser Family Foundation, 47 percent of respondents said they have an unfavorable opinion of the law, while 35 percent said they viewed it favorably. The overwhelming public reaction to the new law has been less than enthusiastic, as the financial burden to patients and physicians alike has increased significantly. We will soon embark upon the second year of enrollment still questionning the effectivenes of the new law.
There’s been some evidence, however, to suggest that some portions of the Affordable Care Act are working as envisioned. A recent study by the UCLA Center for Health Policy Research concluded that the expansion of Medicaid to millions of uninsured people should not have the catastrophic financial impact some predicted because the increases in hospital and emergency room usage are only temporary, and the surge in utilization should subside after the first year of coverage.
The study was completed using two years of claims data from 182,000 low-income, uninsured people enrolled in California’s state-run health insurance programs. The UCLA researchers found that people who previously had had the least medical care used hospital emergency rooms at a high rate, but usage declined sharply by 29 percent in the first quarter, followed by another 25 percent decline the following quarter. Between 2011 and 2013, the overall decline was 69.5 percent and report also found that their hospital admissions declined sharply, by 78.5 percent.
The study is being positioned to set an example of success for states that are on the fence about Medicaid expansion. The authors of the UCLA study said that because California’s Low Income Health Program had provided preventative medical care and regular treatment for chronic diseases, the newly insured were no longer dependent on emergency room treatment and hospitalization. Improving care delivery through the use of an assigned source of primary care, care coordination and health risk assessments, as well as greater availability of specialty services and culturally competent self-care also potentially helped manage pent-up demand.
While this may be good news at the ED level, there are still unknowns about the utilization delta for other patient populations and for other services, such as radiology, and its potential effects over the long-term. We'l all have to stay tuned.