A 2011 report on whether or not Wisconsin’s BadgerCare’s coverage of childless adults affected their utilization of services concluded that people in a sample of about 10,000 very low income childless Milwaukee adults increased their total emergency department visits by 39 percent when they were newly enrolled in Medicaid coverage.
Seventeen percent of visits resulted in a hospital admission before Medicaid was expanded to cover the group. After expansion, 9.5 percent of emergency department visits resulted in a hospital admission.
The report spins this like it was a good outcome: “This significant 45% decline is notable in that Wisconsin Medicaid payment policy considers an ED visit ‘appropriate’ when it results in a hospital admission.” Later on, the report reminded readers that “the percentage of hospital admissions from the emergency department declined dramatically.”
This is playing games with arithmetic — Table 2 shows that the number of emergency department visits considered unavoidable, or not treatable by primary care, did not change significantly. Sixty-two percent of the increased visits were from patients with non-emergent conditions, while 38 percent were from increased accidents and similar events. The number of injuries, presumably another unavoidable reason to go to the emergency department, was unaccountably grouped with visits due to excessive alcohol and drug consumption.
When overall visits increase but unavoidable visits stay the same, unavoidable visits as a percentage of the total will decrease. This provides little support for the proposition that Medicaid expansion reduces hospital admissions from the emergency department.