PPIC Issues Report on ACA Impact on Emergency Department Use

The Public Policy Institute of California (PPIC) this month released a report on emergency department (ED) use in California, analyzing demographics, trends, and the impact of the Affordable Care Act (ACA). The report assesses ED use from 2005 to 2016 with a particular focus on rates of ED use following ACA expansion that occurred in 2014. The report discusses that the large expansion of the Medi-Cal program under the ACA previously raised concerns that the dramatic declines in uninsured residents in a short timeframe may have been contributing to increases in ED use.

According to the PPIC report, no evidence exists that the ACA was responsible for increased ED use in California. Instead, the PPIC analysis suggests ED visit rates for non-elderly adults would have been higher without the coverage expansions provided under the ACA. Key findings of the report include:

• Significant reductions in the number of uninsured Californians as a result of the 2014 ACA expansion did not increase ED use among adults under age 65 and likely reduced ED use among middle-aged adults ages 35-54.
• Among non-elderly adults, women aged 19-34 have the highest rates of ED use, at least partly due to pregnancy-related visits.
• Approximately 90 percent of all ED visits made by adults under age 65 are outpatient visits – patients are treated and released the same day. Only approximately 10 percent of ED visits result in admission to the hospital.
• ED outpatient use has increased substantially across all demographic groups and for all reasons. Non-elderly adults experienced the largest increase (38 percent) during the study period of 2005 to 2016.

The report further discusses that, while the impacts of the ACA are encouraging, the rising use of EDs for complex medical needs warrants further consideration of how EDs fit into the broader healthcare system. As state lawmakers consider further health insurance coverage expansions, according to the report, it will be important to continue monitoring patterns of healthcare use and evaluating efforts aimed at reducing ED use. The full PPIC report is available here.