From time to time Affordable Care Act skeptics have asked me: “The uninsured can always go to an emergency room, can’t they?”
Well, yes. If you have a true emergency, an ER has to take care of you without demanding proof of insurance. But the staff has to treat and stabilize you only for your emergency medical condition; they don’t necessarily have to take care of chronic conditions that may be tormenting you.
And for whatever treatment they do give you, they can hand you a bill you’ll probably find hard to pay.
A new study by the Society of Actuaries gives a hint at what those limits on care for the uninsured have meant and what the formerly uninsured have been doing about it now that they have insurance through the ACA.
This professional organization of actuaries has a partnership with the Kansas Department of Insurance for an ongoing study of how the ACA has affected the insurance market in the state.
Its first report, which mines state claims data, looks at pent-up demand for services among people who gained insurance through the ACA’s federal marketplace last year.
The actuaries examined claims filed during the first three months of 2014 for eight often costly medical services that people frequently put off when they’re uninsured.
They found that, overall, the newly insured filed 53 percent more claims for these services than did people who had also been insured in 2013.
The newly insured had more than six times as many knee replacement surgeries and nearly 21/2 times as many surgeries for lower back pain and endoscopies for upper GI problems like gastroesophageal reflux disease. They also got 51 percent more gallstone procedures.
These procedures were all for what can be very painful conditions, and there’s no telling how long these people had suffered before they gained insurance.
The newly insured ran up bills — paid by the insurance plans and out of pocket by the patients — of about $525,000 for the eight pent-up demand services during the three months the actuaries studied. But by its nature, pent-up demand is a one-time phenomenon, not a continuing expense. Those extra services boosted the overall costs of the newly insured by just 3 percent for the year, the actuaries estimated.
The newly insured also made many more office visits than the previously insured, the actuaries found.
So the new question may be: The newly insured can always go to an emergency room, can’t they?
And the answer will be: Yes, but they no longer have to.