Health Reform Saving Young Adults Millions for ER Care: Study

In 2011 alone, patients and families were spared nearly $150 million in hospital costs

Wednesday, May 29, 2013

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WEDNESDAY, May 29 (HealthDay News) -- An Affordable Care Act provision has shielded thousands of young U.S. adults and their families from millions of dollars in treatment costs for serious medical emergencies, a new study shows.
Starting in September 2010, federal health care reform has required private health plans to cover young adults up to age 25 under their parents' insurance.
More than 22,000 cases of emergency hospital treatment in 2011 involving young adults aged 19 to 25 received coverage under private plans due to the expansion, the study found. The coverage protected patients and parents from an estimated $147 million in hospital charges.
The study was published in the May 30 issue of the New England Journal of Medicine.
"Without this provision, they'd be facing hospital bills," said study author Andrew Mulcahy, a health policy researcher at RAND Health, a nonprofit research organization. "Their family might be on the hook for it. If they can't pay, as a last resort, the hospital might have to eat the cost and write it off. Ultimately, in some states, the taxpayers are on the hook because the state chips in and tries to compensate hospitals for care that is uncompensated."
The study also noted that the provision increased health insurance rates about 3 percent among the young adults who sought emergency treatment.
Recent reports have estimated that this particular provision of the Affordable Care Act has led to the coverage of an additional 3.1 million young adults nationally.
In the study, researchers examined details about emergency medical care provided to adults aged 19 to 31 at 392 hospitals from 2008 through 2011.
The study focused on injuries so severe that the young adults would have to receive emergency treatment regardless of insurance coverage, including broken bones and head injuries.
"We were very careful in looking at the most serious conditions -- conditions so serious you have to go to the ER for treatment," Mulcahy said. "This study is about real-world impact and a very direct test of whether the provision is improving financial protection."
Those sorts of injuries accounted for about 6 percent of emergency department visits by young adults, the researchers concluded.
The research team then compared the coverage of those aged 19 to 25 to patients aged 26 to 31, who were unaffected by the new health care law. That way, they could rule out other trends that might have affected the subjects' insurance coverage.
"We found that the provision resulted in increased financial protection for young adults and the hospitals who provided care for these patients," Mulcahy concluded. "We're careful to say it didn't result in additional visits. It's a shift. The provision didn't lead to more people going to the ER. They would have gone without this provision, but they would have been uninsured."
However, the RAND study's focus on nondiscretionary hospital treatment raises more questions than answers, said health economist Devon Herrick, a senior fellow at the National Center for Policy Analysis, a free-market think tank headquartered in Dallas.
"RAND is touting the financial protection provided by the Affordable Care Act, but then they say only 6 percent of these visits fall under the category of nondiscretionary," Herrick said. "The other 94 percent, to me, is the more interesting story. Are we wasting money on discretionary emergency room treatment? Are they going to the ER for trivial things that would better be left with them covering the cost rather than using their insurance?"
Herrick added that while the study notes in passing a 3 percent increase in insurance rates, it does not go into a more detailed cost-benefit analysis regarding the expanded coverage.
"What is it costing the employers' and parents' health plans, and the young adults?" he asked. "Could the same population have gotten very economical coverage on their own?"

SOURCES: Andrew Mulcahy, health policy researcher, RAND Health; Devon Herrick, health economist and senior fellow, National Center for Policy Analysis; May 30, 2013, New England Journal of Medicine

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