Did the Affordable Care Act reduce emergency department admissions?

Before the Affordable Care Act was signed into law and its provisions started, Californians, especially residents of Los Angeles County, endured some of the longest wait times in emergency departments. Data by the federal Centers for Medicare and Medicaid Services found that in 2013, patients in California waited a little more than 5 hours to be seen. In Los Angeles County, and especially in public hospitals, that wait time could be almost 8 hours. Hospital officials said the increase in admissions at a time when hospitals weren't prepared to take more people, contributed to the long wait times, among other issues.

At the same time, about 22 percent of Californians were uninsured. The state was the first to establish a health care exchange under the Affordable Care Act. Since then, the number of uninsured has been reduced to 11 percent.

Besides insurance coverage, the goal of the Affordable Care Act was to help alleviate overcrowding and long waits at hospital emergency departments. In addition to long waits, some hospital emergency departments had become so negligent that people died while waiting to be seen. An example of how bad the situation had become prior to the ACA, was told in an Los Angeles Times series about Martin Luther King, Jr. Hospital, which cast a spotlight on long emergency waits, and the death of a patient in the waiting room. As a result of the county, state and national spotlight, hospitals were under pressure to reduce wait times.

When the Affordable Care Act was signed, preventative care was highlighted as a way to help people avoid health emergencies and also to encourage patients to manage their chronic illnesses. Community clinics became medical homes to thousands of new patients as millions signed up for insurance on Covered California.

Data from California's Office of Statewide Health Planning already show:

• The percentage of people on Medicare and those with private insurance who visit and are admitted to California's emergency departments is almost the same compared to before the Affordable Care Act was signed.

• People on Medi-Cal who visit the emergency department are more likely to be admitted than those on Medicare or who have private insurance.

• Drugs, and respiratory issues are the most common reasons why people are admitted to the emergency department across California, followed by musculoskeletal or pain issues.

This could be, because the enrollment process happened quickly. Among those newly enrolled in the last two years, about 4 million qualified for Medi-Cal, the state's version of Medicaid. 

While some community clinics were pleased more people chose their sites as their medical homes, the centers were overwhelmed and struggled to provide specialty care.

In addition, community clinics and hospitals, especially in rural areas, are struggling to hire and keep doctors. A report released this year by the Association of American Medical Colleges projected a physician shortage of between 40,800 to 104,900 doctors.

Evidence of the struggles to keep up with those who have coverage and are need of specialty care could be seen last year a large scale clinic was held at the Los Angeles Sports Arena. An estimated 4,000 people signed up to receive free dental, vision, and medical care. Community clinics were sending their patients to the large scale clinic run by the nonprofit Care Harbor, because those community clinics were struggling to offer subspecialty care, as well as refer those patients to larger hospitals, according to organizers.

Specialty care among those patients who use community health centers can take months, even a year, to access, said Dr. Natalie Nevins, who oversees the medical services for Care Harbor (Daily News, Jan. 19, 2017).

“Access to specialty care is very difficult,” Nevins added.

My project will examine the big picture of emergency department use in California and find comparisons among different counties. I would also like to compare emergency department use among three hospitals in Los Angeles County, such as a rural hospital in the Antelope Valley, a public hospital such as Los Angeles County-USC, and a suburban Hospital such as Northridge Medical Center. I'd like to look at how they the same and what makes them different. I'd also like to look at how hospitals are improving emergency department care and what they are developing technologically that can divert people from the emergency rooms.