California ER use jumps despite Medicaid expansion

California is the latest state to report that emergency room usage is up despite expanding Medicaid eligibility.

ER visits by people on Medi-Cal, the state’s Medicaid program, rose 75% over five years from 800,000 in the first quarter of 2012 to 1.4 million in the last quarter of 2016, according to state data.

Illinois, Massachusetts and Oregon report similar trends, which contradict what policy experts thought would happen if people gained more insurance coverage. They could also give Republican lawmakers the ammunition they need to dramatically overhaul Medicaid.

From 2013 to 2016, enrollment in Medi-Cal grew by 57%; 5 million new members were added, bringing current enrollment to 13.5 million. Medi-Cal now covers more than one-third of all Californians, leading some to claim that it’s the closest to universal coverage of any state.

California health officials couldn’t explain the rise, but providers say reimbursement rates have been too low to draw in enough physicians. Therefore, newly enrolled Medi-Cal patients continue to seek care in hospital ERs because they cannot access primary care in physician offices and clinics.

California ranks 47th in the nation for Medicaid payment rates for providers, according to the CMS.

Republicans have already used reports of increased ER use in expansion states and rising spending in the program as reasons to convert Medicaid into a per capita cap system. Medicaid spending nationally rose 4.3% to $575.9 billion in 2016 with the federal share growing 4.5% to $363.4 billion, according to the CMS.