Uninsured Oregonians Flock to Emergency Rooms

By Don Colburn, The Oregonian, Portland, Ore.

Apr. 16–Cuts in the Oregon Health Plan led to “an abrupt and sustained increase” in the uninsured using hospital emergency rooms, a new study reports.

After the state restricted eligibility for publicly funded coverage of low-income Oregonians in 2003, hospital emergency visits by uninsured people jumped 36 percent. Uninsured visits for mental health and problems with alcohol or drugs rose even faster.

While hospital use reflects many factors, “there’s no way to talk yourself out of seeing that abrupt rise right after the OHP cutbacks,” said Dr. Robert Lowe, who led the research. Lowe is director of the Center for Policy and Research in Emergency Medicine at Oregon Health & Science University.

The study is the most detailed analysis of the cuts’ effect on hospital emergency rooms, the most readily available — and most expensive — care in the health care system.

“What we had in Oregon, which most of the country didn’t, was a major cutback in our Medicaid program,” Lowe said.

The findings appear in Annals of Emergency Medicine. To see the article, go to www.annemergmed.com and click on “featured articles.”

Researchers looked at 26 of Oregon’s 58 hospitals, including those accounting for nearly two-thirds of emergency visits statewide and 94 percent in the Portland area. Using the state rollbacks of February and March 2003 as a statistical hinge, they compared month-by-month ER use during the two years before with the two years after.

After accounting for Oregonians who became uninsured through job loss, the study found that Oregon Health Plan cuts resulted in what Lowe called a “disturbing” 20 percent rise in ER use.

At the same time, ER visits by insured patients declined.

Uninsured people who went to the ER also tended to be sicker. Their rate of hospitalization after visiting the ER jumped nearly 50 percent; the rate for others didn’t change.

The good news, Lowe said, is that uninsured Oregonians had a place to go — emergency rooms that, by law, cannot turn patients away. “The bad news,” he said, “is that sometimes they waited too long and were so sick by the time they got there that they had to be hospitalized.”

The Oregon Health Plan is basically Oregon’s form of Medicaid, the federal-state health plan for low-income and disabled residents. The 2003 cuts affected a basic benefit package called OHP Standard, which covers mostly adults in low-paying jobs.

Oregon started kicking enrollees off the health plan if they failed to pay monthly premiums of $6 to $12. The state added co-payments of $50 for emergency room visits and $250 for hospitalization.

The health plan also eliminated out-of-hospital coverage for mental health and problems with drugs and alcohol.

Enrollment in OHP Standard declined from about 103,000 in 2002 to about 51,000 by the end of 2003. About 300,000 other Oregonians who qualify automatically for Medicaid under federal rules were not affected.

Last month, for the first time in nearly four years, the Oregon Health Plan accepted a limited number of new enrollees for its standard benefit package. More than 91,000 people entered the lottery-style competition for 3,000 new slots in March and 3,000 more this month.

As the number of uninsured grows, so does the cost of uncompensated care delivered by hospitals. They make up for that by raising rates for insured patients, and insurers pass the increase along to policyholders in higher premiums.

“This really affects all of us,” Lowe said. “If you’re insured, it’s easy to look at data about the uninsured and say you don’t have to worry about it.

“If only it were that simple.”

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