The study authors speculated that some with private plans were avoiding care due to high out-of-pocket costs associated with going to the hospital. (Photo: Shutterstock)
A new study offers good news and bad news about the Affordable Care Act.
The study by the Urban Institute indicates that those with health coverage through the ACA marketplace receive "significantly less care" in hospital emergency rooms than Medicaid enrollees. That's despite the fact that there is much greater spending associated with each visit for those with private ACA plans.
The average spending for a marketplace enrollee is $2,445 "per unit of care," in the ER compared to only $844 for Medicaid enrollees. For outpatient hospital care the disparity is smaller but nevertheless significant: $522 versus $306.
The study was based on 2014-16 data from the Medical Expenditure Panel Survey (MEPS) Household Component.
Perhaps the most striking difference between the two groups is how much more likely Medicaid enrollees are to visit the ER. During the timeframe that was studied, 23 percent had an ER visit, compared to just over 10 percent of those with private ACA plans.
The study authors speculated that some with private plans were avoiding care due to high out-of-pocket costs associated with going to the hospital, including deductibles and copays. Medicaid enrollees typically don't face significant out-of-pocket costs.
The Urban Institute argues that the study underscores the benefits of expanding Medicaid access, as 38 states have done since the ACA offered significant federal funding to states that granted access to everybody below 138 percent of the federal poverty level.
"Relying more on the ACA marketplace to expand health insurance coverage could increase total expenditures, given marketplace enrollees' higher per capita spending across certain services," says the study. "However, policymakers also need to take other factors into account, such as administrative costs, cost-sharing, and network quality, to know whether expanding Medicaid or marketplace plans is more desirable."
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