Emergency rooms push Medicaid patients out more often than privately-insured people

Emergency rooms push Medicaid patients out more often than privately-insured people

By Nicole Wetsman

Before 1986, emergency rooms in the United States routinely turned patients away at the door if they didn’t have insurance. In fact, it was legal to do so. The Emergency Medical Treatment and Active Labor Act (EMTALA), passed that year, looked to stop that practice: The law mandated that hospitals screen and stabilize any patient, regardless of their ability to pay.

While the law has helped cut down on overt refusal of care, gaps in emergency room access persist, according to research published this week in the Journal of the American Medical Association. Uninsured patients or those on Medicaid who come to the emergency department with pulmonary conditions like pneumonia or asthma are more likely to be transferred to another hospital than patients on private insurance, the study found. They are also more likely to be discharged directly from the emergency department than patients with private insurance.

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The new study also found that patients without insurance or with Medicaid had nearly half the rate of admission after an emergency department evaluation than patients with private insurance. “That was definitely surprising,” Venkatesh says. Prior research has shown that uninsured patients are more likely to be discharged from the emergency department—uninsured patients with brain injuries or other types of trauma, for example, were less likely to be admitted. The pulmonary conditions examined in this study, though, have standard assessments that guide decision making around hospital admission, which the study authors note makes this particular gap stand out.

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