Having health insurance leads to fewer ER visits—NOT

Policy wonks have been touting for decades that if poor people could only be enrolled in health insurance they will use costly emergency rooms less. In truth the opposite happens.  So much for one of the chief rationales for universal coverage.

Per a study published in Science, a trial in Oregon, called the Oregon Health Insurance Experiment, showed that, “…Medicaid coverage significantly increases overall emergency use by 0.41 visits per person, or 40 percent relative to an average of 1.02 visits per person in the control group.” Moreover Medicaid deductibles are negligible.

Anyone who believed that enrolling poor people in health insurance would lead to fewer ER visits doesn’t know much about the reasons people use ERs in the first place. Since that report came out I’ve had conversations with two people who have worked in ER’s. Nether was remotely surprised by the Oregon finding. 

It seems lot of health policy wonks have an abundance of crow to eat.  But then that’s not exactly news.


Tom Emerick

Cracking Health Costs, the book, is now available on Amazon at a deeply discounted price.  Click here:  Cracking Health Costs: How to Cut Your Company’s Health Costs and Provide Employees Better Care by Tom Emerick and Al Lewis.

Tom Emerick is the President of Emerick Consulting and co-founder of Edison Health. In December 2012, Tom was listed in Forbes.com as one of 13 unsung heroes changing healthcare forever. In 2009, Tom was named by Healthspottr as one of the top 100 innovators in healthcare in the US for his work on medical ethics. Prior to consulting, Tom spent a number of years working for large corporations: Walmart Stores, Burger King, and British Petroleum.


  1. Tom, I usually nod my head when I read your posts but not this time. Many hard core health wonks (myself included) know that there are good reasons that those with insurance use the emergency room more rather than less. Here’s a post I wrote about the subject back in 2006 http://healthbusinessblog.com/2006/07/20/is-the-ma-health-care-reform-law-built-on-shaky-assumptions/

    Still, I don’t think it’s a great argument against universal coverage that people with insurance access the system more.

  2. Tom Emerick says:

    Thanks for the comment David, and thanks for reading this blog.

    I didn’t intend for my comments to be seen as a condemnation of universal coverage, rather a criticism of of one of the selling points of universal coverage.

    Your article was terrific.



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