Impact of the Affordable Care Act Medicaid expansion on emergency department high utilizers with ambulatory care sensitive conditions: A cross-sectional study.
OBJECTIVES
The effect of the Affordable Care Act on emergency department (ED) high utilizers has not yet been thoroughly studied. We sought to determine the impact of changes in insurance eligibility following the 2014 Medicaid expansion on ED utilization for ambulatory care sensitive conditions (ACSC) by high ED utilizers in an urban safety net hospital.


METHODS
High utilizers were defined as patients with ≥4 visits in the 6months before their most recent visit in the study period (July-December before and after Maryland's Medicaid expansion in January 2014). A differences-in-differences approach using logistic regression was used to investigate if differences between high and low utilizer cohorts changed from before and after the expansion.


RESULTS
During the study period, 726 (4.1%) out of 17,795 unique patients in 2013 and 380 (2.4%) of 16,458 during the same period in 2014 were high utilizers (p-value <0.001). ACSC-associated visit predicted being a high utilizer in 2013 (OR 1.66 (95% CI [1.37, 2.01])) and 2014 (OR 1.65 (95% CI [1.27, 2.15])) but this was not different between years (OR ratio 0.99, 95% CI [0.72, 1.38], p-value 0.97).


CONCLUSION
Although the proportion of high utilizers decreased significantly after Maryland's Medicaid expansion, ACSC-associated ED visits by high ED utilizers were unaffected.
['Gingold|Daniel B|DB|', 'Pierre-Mathieu|Rachelle|R|', 'Cole|Brandon|B|', 'Miller|Andrew C|AC|', 'Khaldun|Joneigh S|JS|']
D000328:Adult D000553:Ambulatory Care D003430:Cross-Sectional Studies D004636:Emergency Service, Hospital D005249:Fees and Charges D005260:Female D006297:Health Services Accessibility D006801:Humans D019458:Insurance Coverage D008297:Male D008396:Maryland D008484:Medicaid D058991:Patient Protection and Affordable Care Act D012189:Retrospective Studies D014481:United States
Affordable Care Act Medicaid expansion Ambulatory care sensitive conditions ED utilization