Harvard University released a startling new study this week that showed that individuals on Medicaid use the Emergency Room 40% more than individuals who are uninsured. The study, which followed Oregon’s expanded Medicaid lottery, showed that the expansion of Medicaid increased, rather than decreased, the use of the Emergency Room for non-emergency visits. The study also showed that the uninsured individuals who stayed uninsured were no less healthy than those who were able to get Medicaid coverage under Oregon’s Medicaid expansion. This study’s results fly in the face of President Obama’s promises that expanding Medicaid would reduce the overuse of Emergency Rooms by giving people more access to primary care doctors.
Another part of this, which wasn’t discussed in the study, is that the use of Emergency Medical Services, such as ambulance transfers and the use of paramedics as a quick fix for Medicaid patients, will also go up with the expansion of Medicaid under Obamacare.
I recently spoke with a FireMedic who works in an area that has a high minority population and a high enrollment in Medicaid. He told me that due to the fact that Medicaid covers ambulance transfers and 911 calls, many individuals use 911 and the Fire Department as little more than a doctor on wheels and a car service. Basically, all these individuals have to do is call up 911 and say “My child has a fever” or “I don’t feel very good – I need to go to the ER” and the Fire Department will dispatch a team of paramedics to their homes to provide care. If the patient needs any type of medical care and the patient wants to go to the ER, the Fire Department will take them – simple as that. Many times the requests are tedious, but that is not for Fire Department to decide and most times, as long as it isn’t specifically stated to be non-emergency, Medicaid will pay for the ride to the ER.
The FireMedic who I spoke with provided me with a list of some of the craziest (lamest) calls he has received in recent memory:
• A middle-age woman with no visible injury wanted to go to the ER because she “fell a few days ago” and her “arm was sore”.
• A woman called saying her child “might have a fever” and she wanted the child checked in ER. (The child was afebrile.)
• A mother, whose child had mild cold symptoms, said she had Medicaid and wanted to take her child to the ER but didn’t have enough gas in her car…
Another call he told me about was a woman with a young child who requested the child be taken to the ER to be checked out. Even though the child seemed normal to the paramedics, and since the woman requested that the child be seen at the ER, the paramedics had to grant the mother’s wishes just in case there really was a problem with the child. On the way to the hospital the mother was overheard making a phone call where she said that she would “be at the party” in an hour…So the obvious conclusion was that the woman was making up a reason for her child to go to the ER so that she could get a ride into town to attend a party.
Even if Medicaid, for some reason or another, decides not to pay for these ridiculous transfers, the taxpayers will still be left with the bill due to the fact that these Medicaid subscribers were under the impression that Medicaid would cover it and can’t afford to pay for the transfers themselves.
However, in many cases Medicaid will pay for these requests. According to the Kaiser Foundation, 42 states cover all ambulance transfers and the remaining 8 states will cover all emergency transfers and will cover non-emergency transfers with a pre-approval or small co-pay (usually $1 to $2).
So how much does it cost to cover these petty calls? It depends on the state, but according to one report for the State of Florida, Medicaid pays anywhere from $136 to $295 per transfer depending on the severity. Add that on top of an already frivolous ER visit and there goes a lot of hard earned taxpayer dollars down the drain.
Another issue with Medicaid patients using the Fire Department as a “car service” is even though Medicaid may only pay $136 to $295 for the service, the cost to the city or county is much higher. If a regular taxpayer had to pay for ambulance service and their insurance didn’t cover the ride, a non-Medicaid individual would pay anywhere from $500 to $1000 for the same service.
It is sad that the expansion of Medicaid will cause not only an increase in frivolous ER visits, but it will also cause an increase in the misuse of other emergency services resulting in the waste of millions of taxpayer dollars. However, the FireMedic I spoke to wasn’t as concerned about saving money as he was worried about saving lives. According to him, the biggest problem with this type of abuse of emergency services is that it takes away from the care that is needed by people who are facing “real emergencies”.
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