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   From: suckers@hillaryclinton.com   
      
   Three-quarters of emergency physicians say they’ve seen ER   
   patient visits surge since Obamacare took effect — just the   
   opposite of what many Americans expected would happen.   
      
   A poll released Monday by the American College of Emergency   
   Physicians showed that 28 percent of 2,099 doctors surveyed   
   nationally saw large increases in volume, while 47 percent saw   
   slight increases. By contrast, fewer than half of doctors   
   reported any increases last year in the early days of the   
   Affordable Care Act.   
      
   In Ohio, emergency room visits dropped by more than 68,000   
   during the first three months of 2014 compared with the same   
   time in 2013. However, ER visits were higher in the second   
   quarter of 2014 compared with the same months in 2013, Ohio   
   Hospital Association spokesman John Palmer said. Data on the   
   second half of 2014 were not available.   
      
   Such hikes run counter to one of the goals of the health care   
   overhaul, which is to reduce pressure on emergency rooms by   
   getting more people insured through Medicaid or subsidized   
   private coverage and providing better access to primary care.   
      
   A major reason that hasn’t happened is there simply aren’t   
   enough primary care physicians to handle all the newly insured   
   patients, said ACEP President Mike Gerardi, an emergency   
   physician in New Jersey.   
      
   “They don’t have anywhere to go but the emergency room,” he   
   said. “This is what we predicted. We know people come because   
   they have to.”   
      
   Palmer said he wasn’t certain what caused the fluctuations in   
   Ohio ER use, and noted ER visits were down in 2013 from the   
   previous year. A Health Policy Institute of Ohio report found ER   
   visits had not increased dramatically because of Medicaid’s   
   expansion.   
      
   Experts cited many root causes. In addition to the nation’s long-   
   standing shortage of primary care doctors — projected by the   
   federal government to exceed 20,000 doctors by 2020 — some   
   physicians won’t accept Medicaid because of its low   
   reimbursement rates.   
      
   That leaves many patients who can’t find a primary care doctor   
   to turn to the ER — 56 percent of doctors in the ACEP poll   
   reported increases in Medicaid patients.   
      
   Four in 10 Ohio primary care physicians said they would drop   
   Medicaid patients when a financial incentive to treat them ended   
   at the beginning of 2015.   
      
   Emergency room use is bound to increase if there’s a shortage of   
   primary care doctors who accept Medicaid patients and “no   
   financial penalty or economic incentive” to move people away   
   from ERs, said Avik Roy, a health care policy expert with the   
   free market Manhattan Institute.   
      
   “It goes to the false promise of the ACA,” Roy said, that   
   Medicaid recipients are “given a card that says they have health   
   insurance, but they can’t have access to physicians.”   
      
   Complicating matters, low-income patients face many obstacles to   
   care. They often can’t take time off from work when most primary   
   care offices are open, whereas ERs operate around the clock and,   
   by law, must at least stabilize patients. Waits for appointments   
   at primary care offices can stretch for weeks, whereas ERs must   
   see patients almost immediately.   
      
   “Nobody wants to turn anyone away,” said Maggie Gill, CEO of   
   Memorial University Medical Center in Savannah, Georgia. “But   
   there’s no business in this country that provides resource-   
   intensive anything and can’t even ask if you’re going to be able   
   to pay.”   
      
   Some people who have been uninsured for years don’t have regular   
   doctors and are accustomed to using ERs, even though they are   
   much more expensive. A 2013 report from the Robert Wood Johnson   
   Foundation found going to an ER when a primary care visit would   
   suffice costs $580 more for each visit.   
      
   Gerardi acknowledges that some people come to the ER for   
   problems that would be better handled in a primary or urgent   
   care office. But he said the ER is the right place for patients   
   with vague but potentially life-threatening symptoms, such as   
   chest pain, which could be anything from a heart attack to   
   indigestion.   
      
   Still, 7 in 10 doctors say their emergency departments aren’t   
   ready for continuing, and potentially significant, increases in   
   volume. Although the numbers should level off as people get care   
   to keep their illnesses under control, Alagia said, “the patient   
   demand will outstrip the supply of physicians for a while.”   
      
   Gannett Ohio’s Jessie Balmert contributed to this report.   
      
   http://www.mansfieldnewsjournal.com/story/news/local/2015/05/04/   
   contrary-goals-er-visits-rise-obamacare/26901521/   
       
      
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