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I Hate To Say I Told You So…

… but I told you so.

On KevinMD, we find a story that Oregon Medicaid recipients are 40% more likely to go to the ED – far more expensive care -than their primary care physician:

The Oregon Medicaid findings highlight a central flaw in the Affordable Care Act. Expanding insurance without expanding the primary care infrastructure drives more patients to the hospital. Until that is effectively addressed, expect more newly insured patients beyond Oregon to use the emergency department for primary care.

I’ve been saying all along that this is one reason the ACA will further destabilize the system and drive up costs. You cannot add 30 million people to the Medicaid rolls, people with no financial stake in using the resources appropriately, and expect that they will utilize it less.

With accepting Medicaid a money-losing proposition and little worth the bureaucratic hassle, and primary care physicians being reimbursed so poorly already, fewer med school graduates are choosing primary care over more lucrative specialties, and many of those that do are adopting cash-only, concierge practices.

And an ever-growing number of practicing primary care physicians are refusing to take new Medicaid patients.

So what good is having health care coverage, if nobody in your city accepts it?

Medicaid recipients are going to do what they’ve always done; treat the ED as their default primary care clinic. That’s the most expensive, fragmented type of care, and a substantial portion of them will rely upon the EMS system to get them there.

When it comes to healthcare, your choices are quality care, easy access, and low cost.

Pick any two, because having all three ain’t possible. Anyone who says otherwise is either a liar or a politician.

But then, I repeat myself.