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</o:shapelayout></xml><![endif]--></head><body lang=EN-US link="#0563C1" vlink="#954F72"><div class=WordSection1><p class=MsoNormal><span style='font-size:9.0pt;font-family:"Arial",sans-serif'>       <img width=623 height=151 style='width:6.4895in;height:1.5729in' id="Picture_x0020_1" src="cid:image001.jpg@01D20C72.C16D3350" alt="Description: Description: Description: Description: CAL/AAEM: California Chapter of the American Academy of Emergency Medicine"><o:p></o:p></span></p><p class=MsoNormal><span style='font-size:9.0pt;font-family:"Arial",sans-serif'><o:p> </o:p></span></p><div style='margin-left:15.0pt;margin-top:7.5pt;margin-right:15.0pt;margin-bottom:7.5pt' id=content><div style='border-top:solid #7F7F7F 1.0pt;border-left:none;border-bottom:solid #7F7F7F 1.0pt;border-right:none;padding:4.0pt 0in 4.0pt 0in'><p class=MsoNormal><b><span style='font-size:11.0pt;font-family:"Arial",sans-serif;color:#7F7F7F'>August 9, 2016<o:p></o:p></span></b></p></div><div style='margin-top:11.25pt;margin-bottom:11.25pt'><p class=MsoNormal><b><span style='font-size:12.5pt;font-family:"Arial",sans-serif;color:#DF0009'><o:p> </o:p></span></b></p><p class=MsoNormal><b><span style='font-size:12.5pt;font-family:"Arial",sans-serif;color:#DF0009'>Study: Affordable Care Act provision had little effect on ER use<o:p></o:p></span></b></p><p class=MsoNormal><span style='font-family:"Arial",sans-serif;color:#0070C0'><o:p> </o:p></span></p><p class=MsoNormal><span style='font-family:"Arial",sans-serif;color:#0070C0'><o:p> </o:p></span></p><p class=MsoNormal><span style='font-family:"Arial",sans-serif;color:#0000CC'><a href="http://www.fiercehealthcare.com/payer/study-medicaid-expansion-had-little-effect-er-use?utm_medium=nl&utm_source=internal&mrkid=905528&mkt_tok=eyJpIjoiT0daaFpqQXhORFZqTW1GaSIsInQiOiJ6c1I4YitvWUYraHArMEFsWXhXTkFmQVNrTWtRa2J4eVdoXC85V1MxZktPXC91RTMxbGlsMm5KbitDQnJRd3B1ZVozdXB2UnNLRklVTytVKzBaVkNKY2ZFM0ljRnRNdUVpd3kwUGhiQm9vejQ0PSJ9"><span style='color:#0000CC'>Fierce Healthcare</span><span style='font-family:"Times New Roman",serif;color:#0000CC'><o:p></o:p></span></a></span></p><p class=MsoNormal style='margin-right:15.7pt'><span style='font-family:"Arial",sans-serif'><o:p> </o:p></span></p><p class=MsoNormal><span style='font-family:"Arial",sans-serif'><o:p> </o:p></span></p><p class=MsoNormal><span style='font-family:"Arial",sans-serif'>By Leslie Small<o:p></o:p></span></p><p class=MsoNormal><span style='font-family:"Arial",sans-serif'><o:p> </o:p></span></p><p class=MsoNormal><span style='font-family:"Arial",sans-serif'>Despite what some policymakers predicted, Medicaid expansion did not significantly affect patients’ use of emergency departments, according to a new study, but it did alter the mix of insurance coverage among ED patients.<o:p></o:p></span></p><p class=MsoNormal><span style='font-family:"Arial",sans-serif'><o:p> </o:p></span></p><p class=MsoNormal><span style='font-family:"Arial",sans-serif'>The study, published in the August issue of Health Affairs, examined the effect of expanded Medicaid eligibility on ED use in 478 hospitals in 36 states in 2014. Here’s what it found:<o:p></o:p></span></p><p class=MsoNormal><span style='font-family:"Arial",sans-serif'><o:p> </o:p></span></p><p class=MsoListParagraph style='mso-margin-top-alt:11.25pt;margin-right:15.0pt;margin-bottom:11.25pt;margin-left:30.0pt;text-indent:-.25in;mso-list:l0 level1 lfo1'><![if !supportLists]><span style='font-family:Wingdings'><span style='mso-list:Ignore'>è<span style='font:7.0pt "Times New Roman"'> </span></span></span><![endif]><span style='font-family:"Arial",sans-serif'>The number of Medicaid-paid ED visits in Medicaid expansion states increased by 27.1 percent compared to non-expansion states.<o:p></o:p></span></p><p class=MsoListParagraph style='mso-margin-top-alt:11.25pt;margin-right:15.0pt;margin-bottom:11.25pt;margin-left:30.0pt;text-indent:-.25in;mso-list:l0 level1 lfo1'><![if !supportLists]><span style='font-family:Wingdings'><span style='mso-list:Ignore'>è<span style='font:7.0pt "Times New Roman"'> </span></span></span><![endif]><span style='font-family:"Arial",sans-serif'>The share of uninsured ED visits decreased by 31.4 percent in expansion states compared to non-expansion states.<o:p></o:p></span></p><p class=MsoListParagraph style='mso-margin-top-alt:11.25pt;margin-right:15.0pt;margin-bottom:11.25pt;margin-left:30.0pt;text-indent:-.25in;mso-list:l0 level1 lfo1'><![if !supportLists]><span style='font-family:Wingdings'><span style='mso-list:Ignore'>è<span style='font:7.0pt "Times New Roman"'> </span></span></span><![endif]><span style='font-family:"Arial",sans-serif'>Privately insured ED visits dipped by 6.7 percent in expansion states compared to non-expansion states.<o:p></o:p></span></p><p class=MsoNormal><span style='font-family:"Arial",sans-serif'><o:p> </o:p></span></p><p class=MsoNormal><span style='font-family:"Arial",sans-serif'>Total ED visits, meanwhile, grew 2.9 percent in 2014 compared to 2013--similar to historical rates of ED visits, which have grown at an average annual rate of 2.3 percent between 1997 and 2007. This suggests that ED use for those newly insured with Medicaid was not substantially different than for previously uninsured individuals, the researchers write.<o:p></o:p></span></p><p class=MsoNormal><span style='font-family:"Arial",sans-serif'><o:p> </o:p></span></p><p class=MsoNormal><span style='font-family:"Arial",sans-serif'>To explain this finding, which differs from previous research, the study points to several factors. For one, the ACA’s temporary “Medicaid payment parity” provision might have made it easier for new Medicaid beneficiaries to access primary care, in turn decreasing demand for ED services.<o:p></o:p></span></p><p class=MsoNormal><span style='font-family:"Arial",sans-serif'><o:p> </o:p></span></p><p class=MsoNormal><span style='font-family:"Arial",sans-serif'>Indeed, a study published recently in JAMA Internal Medicine found that Kentucky’s Medicaid program and Arkansas’ private option for Medicaid expansion increased outpatient utilization, boosted preventive care, improved healthcare quality, reduced ED use and improved self-reported health.<o:p></o:p></span></p><p class=MsoNormal><span style='font-family:"Arial",sans-serif'><o:p> </o:p></span></p><p class=MsoNormal><span style='font-family:"Arial",sans-serif'>Further, those newly eligible for Medicaid under the ACA in states that expanded eligibility differ from the populations traditionally served by Medicaid, which could affect how they choose to access the ED, the Health Affairs study notes.<o:p></o:p></span></p><p class=MsoNormal><span style='font-family:"Arial",sans-serif'><o:p> </o:p></span></p><p class=MsoNormal><span style='font-family:"Arial",sans-serif'>Regardless of the reasons for the study’s results, however, the researchers add that it is “favorable news for the cost associated with the ACA as well as other efforts to expand health insurance coverage in the United States.”<o:p></o:p></span></p><p class=MsoNormal style='margin-right:30.95pt'><span style='font-family:"Arial",sans-serif'><o:p> </o:p></span></p></div><p class=MsoNormal style='margin-right:15.75pt'><span style='font-family:"Arial",sans-serif'><o:p> </o:p></span></p><p class=MsoNormal style='margin-right:15.75pt'><span style='font-family:"Arial",sans-serif'><o:p> </o:p></span></p><p class=MsoNormal><strong><span style='font-family:"Arial",sans-serif'>Jeff Wells</span></strong><span style='font-family:"Arial",sans-serif'><br>Deputy Editor, CAL/AAEM News Service<o:p></o:p></span></p><p class=MsoNormal><span style='font-family:"Arial",sans-serif'><o:p> </o:p></span></p><p class=MsoNormal><strong><span style='font-family:"Arial",sans-serif'>Brian Potts</span></strong><b><span style='font-family:"Arial",sans-serif'> MD, MBA</span></b><span style='font-family:"Arial",sans-serif'><br>Managing Editor, CAL/AAEM News Service<br><br></span><o:p></o:p></p></div><p class=MsoNormal style='background:#D9D9D9'><span style='font-size:7.5pt;font-family:"Verdana",sans-serif'>Contact us at: <span style='color:#0000CC'><a href="mailto:calaaem.news.service1@gmail.com"><span style='color:#0000CC'>calaaem.news.service1@gmail.com</span></a></span><br><br>For more articles, visit our <span style='color:blue'><a href="http://www.calaaem.org/news_archives.php"><span style='color:blue'>archives</span></a></span>. <br><br></span><span style='font-size:9.0pt;font-family:"Arial",sans-serif'><a href="mailto:somcaaem@uci.edu"><span style='font-size:7.5pt;font-family:"Verdana",sans-serif;color:black;text-decoration:none'>To</span></a></span><span style='font-size:7.5pt;font-family:"Verdana",sans-serif;color:#0070C0'><a href="https://maillists.uci.edu/mailman/listinfo/calaaem"><span style='color:#0070C0;text-decoration:none'> </span><span style='color:blue'>unsubscribe</span></a></span><span style='font-size:7.5pt;font-family:"Verdana",sans-serif'> from this list, visit our mail server.<br><br>Copyright (C) 2015. The California Chapter of the American Academy of Emergency Medicine (CAL/AAEM).</span> <span style='font-size:7.5pt;font-family:"Verdana",sans-serif;color:#0000CC'><a href="http://www.calaaem.org"><span style='color:#0000CC'>http://www.calaaem.org</span></a></span><span style='font-size:7.5pt;font-family:"Verdana",sans-serif'>. All rights reserved.<br><br>CAL/AAEM, a nonprofit professional organization for emergency physicians, operates the CAL/AAEM News Service solely as an educational resource for physicians. Dissemination of an article by CAL/AAEM News Service does not imply endorsement, agreement, or recommendation by CAL/AAEM News Service, CAL/AAEM, or AAEM.<br><br><o:p></o:p></span></p><p class=MsoNormal style='background:#D9D9D9'><b><span style='font-size:7.5pt;font-family:"Verdana",sans-serif'>Follow CAL/AAEM on Facebook and Twitter:<o:p></o:p></span></b></p><p class=MsoNormal style='background:#D9D9D9'><span style='font-size:7.5pt;font-family:"Verdana",sa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