- 4) The free market rule is supply and demand. With increased demand from 470,000 new patients receiving reimbursed care they do not have to pay for, demand for services will increase prices for all of us.
- 5) Medicaid patients statistically demand more services, stay in hospitals longer, and still have poorer outcomes and greater mortality rates. How does making this available to another half million people translate into lower premiums?

The National Center for Policy Analysis (NCPA) raised some points in 2010 addressing this directly.  Reminding us that even the Congressional Budget Office warned of increasing use of services. That Obamacare would eventually cause 32 million uninsured people to obtain health insurance they otherwise would not have had, including HALF of those enrolling in taxpayer funded Medicaid.  They noted the problems associated with the coming increase:

"Emergency Room Use. A common myth is the belief that the uninsured use the emergency room a lot more than people with private health insurance. Yet as the figure shows, the percent of uninsured going to hospital emergency rooms every year is not much higher than for those with private insurance. (And after adjusting for health status, there is no difference in the average number of visits.) Medicaid enrollees, on the other hand, visit emergency rooms significantly more often than either the insured or the uninsured.

Why is that? The main reason appears to be that Medicaid fees are so low that patients have difficulty finding private practitioners who will see them. Often, the emergency room turns out to be the only place they can access care. Studies show that even the uninsured have an easier time making doctors' appointments than Medicaid enrollees.

Predicting Emergency Room Use Based on Change in Health Insurance Status. Assuming that 1) half the uninsured obtain insurance; 2) the newly insured enroll 50/50 in Medicaid and private plans; 3) the newly insured are reflective of the current uninsured population; and 4) the newly insured behave in a way similar to other enrollees in the plans they join:

• Among the newly insured under age 18, the number going to the emergency room each year will climb from 18 percent to 22 percent.
  
• Among those ages 18 to 44, annual emergency room traffic by the newly insured will increase from 21 percent to 28 percent.
  
• Among those ages 45 to 64, the increase will be from 19 percent to 28 percent.

In terms of the actual number of visits, emergency room use by the uninsured and the privately insured are about the same. Medicaid enrollees, on the other hand, have more than twice as many visits. Consequently, we project that insuring between 32 million and 34 million additional people will generate between 848,000 and 901,000 additional emergency room visits every year.

Now Michigan legislators who stood firm AGAINST this expansion are seeing the first warning signs in Oregon, and hopefully they are feeling appropriately vindicated for their strength and foresight.

The others who voted for it, including the a governor who lied (or was too ignorant to look at the predictors) will have to wipe the egg off their faces.  The higher costs associated with reimbursed emergency room visits will likely shorten the small window of financial advantage Michigan's leaders THOUGHT they had achieved.  

Diffusing the bomb that is Obamacare just took a bad turn for the McGuyvers in Lansing. The wrong wire was cut.