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There’s not a crisis of uninsured people overusing the emergency room

Busting a persistent myth.

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Dylan Scott covers health care for Vox. He has reported on health policy for more than 10 years, writing for Governing magazine, Talking Points Memo and STAT before joining Vox in 2017.

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If you haven't noticed, I love some good new research that challenges the conventional wisdom. We've got a live one today.

You hear it everywhere you go, from true experts to lawmakers to the average Joe or Joan on the street: The uninsured just go to the emergency room when they need medical care, and that's one thing that keeps driving up our health care costs.

But a new paper at Health Affairs, authored by researchers from Harvard, the University of Chicago, and MIT, challenges that assumption.

They actually found that uninsured adults go to the emergency room about as much as people with private insurance (12.2 percent of the uninsured made an ER visit in 2013 compared to 11.1 percent of the privately insured) and much less than the people on Medicaid (29.3 percent).

So uninsured Americans don't actually go to the ER any more than people with insurance: 13.7 percent across private and public coverage.

But the uninsured do, this study found, get outpatient care less frequently.

Much, much less frequently.

It's an interesting twist on one of the most commonly pondered problems of American health care. The problem is not so much that the uninsured go to the emergency room more than other people.

The problem might be instead that they don't get other kinds of care as often. Why is that? The authors wrapped up their findings like this:

The Emergency Medical Treatment and Labor Act (EMTALA) provides the uninsured with a legal right to care through the ED, although it does not protect them against the financial consequences of expensive ED visits.

The uninsured, however, may be legally denied care in non-ED settings. Other nonfinancial barriers to health care access for poor populations — both insured and uninsured — include factors such as stigma, difficulty finding and building relationships with providers, and confusion about insurance benefits or the cost of care.

Our misconception about the uninsured and the emergency room might live on because they "are most likely encountered in the ED," the authors wrote.

And given what we know about primary care (the most basic form of outpatient care) and early intervention in preventing illness and deaths, this is another the data point to consider as we debate the value of universal health coverage.

Very Important Story of the Day

"Healthcare is a single word because it’s a single concept."


For example, "mental health care" is care for mental health. "Mental healthcare" would mean that the healthcare itself is mental, which is not a thing.

The great “health care” debate of 2017. When the AP Stylebook suggested it might revisit its guidance that "health care" is two words (which it is), Health Policy Twitter exploded. It was a little silly but also a lot of fun — and, I'd argue, forces you to think about what health care really is.

Josh Zeitlin at the Advisory Board Company did a nice job of summarizing everybody's feelings. The quotes above from Ashish Jha, a physician and a professor at the Harvard T.H. Chan School of Public Health, and Sam Baker at Axios staked out the positions well.

Kliff’s Notes

With research help from Caitlin Davis

Today's top news

Analysis and longer reads

  • “Forget Amazon. Health Companies Really Want to Be UnitedHealth”: “As the specter of Inc. looms over the health-care industry, it’s easy to see the tech giant’s threat as a major factor behind the megadeal between CVS Health Corp. and Aetna Inc. Yet the $67.5 billion deal will build a company to match up against a rival that already has businesses spread deep across the sector: UnitedHealth Group Inc.” —Zachary Tracer, Bloomberg
  • “Aetna, CVS merger sparks talk of Humana eyeing deal with Walmart”: “The $69 billion merger between CVS Health and Aetna, announced by CVS on Sunday, has spurred industry analysts to talk about a possible deal between Walmart and Humana, as the retailer feels the increased competition from an integrated pharmacy business and is currently in an arms race against online giant Amazon.” —Susan Morse, Healthcare Finance
  • “Dangling A Carrot For Patients To Take Healthy Steps: Does It Work?”: “Overall, research on the effectiveness of financial incentives for the Medicaid population has been mixed. A report this year by the Center on Budget and Policy Priorities found that they can induce people to keep an appointment or attend a class but are less likely to yield long-term behavior changes, such as weight loss.” —Anna Gorman, Kaiser Health News

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Correction: This article originally misstated the university of one of the authors of the researcher paper. The author is from the University of Chicago, not the University of Illinois.

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