Tag: "ER"

Is this the Insurance Casualty Model; Or Just a Dirty Trick?

The health insurance “Casualty Model” is alive and well in Georgia — but only as a punishment for not signing an in-network agreement or accepting usual and customary reimbursement for emergency room treatments.  At issue is a Georgia hospital (and one in Los Angeles) that are not part of the Blue Cross and Blue Shield of Georgia network. Because neither of the hospitals are part of the insurer’s network, when covered individuals go to the hospitals’ emergency rooms, the insurer sends reimbursement checks for emergency care directly to enrollees. The enrollees are then supposed to endorse the checks over to the hospital.  This is similar to the casualty model when an insurer provides funds for a covered claim and the covered individual shops around and receives a service at the provider of their choice. When someone slid into my car during an ice storm a few years ago, an adjuster came to my office and calculated an estimate. I received the check and was told I could get my car repaired almost anywhere for the estimated amount.

Headlines I Wish I Hadn’t Seen

Hits and Misses

Hits and Misses

Headlines I Wish I Hadn’t Seen

Hits and Misses

Headlines I Wish I Hadn’t Seen

Least Surprising Health Research Result Ever: Medicaid Increases ER Use

Medicaid is a welfare program jointly funded by federal and state governments, which claims to provide health insurance to low income people. A few years ago, Oregon expanded Medicaid enrollment by lottery. This created an excellent environment to study the effects of being uninsured versus being enrolled in Medicaid, because it approximated a randomized-controlled trial — the gold standard of medical research, but seldom conducted in the social sciences.

20131231104928-0The latest result of the study, published in Science, reported that Medicaid increased use of emergency rooms by 40 percent (gated abstract here, and reported here).

This result is important for anticipating the consequences of ObamaCare. About half of the 30-plus million people expected to get health insurance under ObamaCare will be enrolled in Medicaid, not private health insurance. Already, the Administration asserts that four million new Medicaid enrollees have signed up via ObamaCare (but this estimate has been questioned).

Medicaid Expansion Means More ER Visits

A number of years ago, Governor Romney told me that under Massachusetts health reform people would go to physicians’ offices for care instead of going to the emergency room. He wasn’t saying that Massachusetts would deliver more care. He was saying that the care would be more appropriate and less expensive.

As it turns out he was wrong. Traffic to the ER in Massachusetts today is higher than it was before the state’s health reform was enacted.

er23The same argument has been used by President Obama and by supporters of the Affordable Care Act. And now it turns out they are wrong too. As The New York Times reports:

The study, published in the journal Science, compared thousands of low-income people in the Portland area who were randomly selected in a 2008 lottery to get Medicaid coverage with people who entered the lottery but remained uninsured. Those who gained coverage made 40 percent more visits to the emergency room than their uninsured counterparts during their first 18 months with insurance.

This is consistent with our own predictions in an NCPA study done soon after the ACA was passed. Ah, if only they had listened.

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