How many Government sponsored “projections” do we need to see before we learn NOT to trust them? Let’s look at just a couple.

It’s one of the oldest and most proven opinions or statements about government and that is concerning government projections and their accuracy. In a speech in the 1980s President Reagan reminded us all of one of the scariest statements known to citizens: “Hello, I’m with the Government and I’m here to help.”?

In our current situation concerning the ACA we can identify many examples of how the Government said it was going to help us but actually did not and too often made things worse. One thing the ACA did accomplish, which I’ve addressed before, was to make coverage guaranteed issue with no pre-ex for individuals. To many that is/was the only improvement to America’s healthcare financing system.
ACA proponents would add the expansion of Medicaid as a positive. But then, if you make something free, even if it is not good coverage for folks, aren’t the proponents always going to crow about it.

The real focus of this post is the failure of projections concerning the utilization of Emergency Rooms if everyone is covered but first let’s remind ourselves of a few other missed projections. Such as:
* If you like your Doctor you can keep your Doctor.
* If you like your plan you can keep your Plan.
* Premiums will drop by $2,500 per year.
* The ACA exchanges will cover 25 million people
* People will stop using ERs as their primary provider.

That last one is where we will focus because not only is it another incorrect projection but it is one that has dramatic impact on the healthcare system in both cost and access.  Statistics reveal in California, courtesy of Ca’s Office of Statewide Health Planning and Development, that ER visits by Medi-Cal members increased 75% over the 5 year period from January 2012 through December 2016. The 1st quarter of 2012 reported 800,000 ER visits while the 4th quarter of 2016 reported 1.4 million visits.

That means that Emergency Rooms in California had/have to accommodate 600,000 more patients per quarter which one can correctly assume are not really people in an emergency situation. This outcome and missed projection clearly impacts California’s ERs ability to provide emergency service to the folks truly in need of an ER.

Plus the cost of ER services are generally higher per unit cost that non-emergency care rendered by local primary care Doctors. The result then is more visits and higher cost per unit of service while clogging an already overloaded ER environment for those in true need of ER services. That probably explains as well as anything could the impact of well-intended but misguided government intervention.

Why are the ERs seeing these overwhelming numbers? Again, much is conjecture but in this case it is well founded.
*  Many primary Docs (lots of them) don’t accept Medi-Cal (Medicaid) patients so the newly covered folks under the ACA Medicaid expansion have fewer providers to see than members under private coverage. Medicaid/Medi-Cal reimburse private Doc far less so can you blame them for not wanting to clog their own waiting rooms?

* Prior to the ACA folks not covered still had access to care and could use their local ERs because those providers can not deny care to anyone who enters through their doors. Most ERs are associated with hospitals and those hospitals can not turn people away so the ERs have no choice but to provide care to everyone even for just a cold or the flu.

The purpose of this post is just to be a reminder that as we see the CBO and others make projections about the outcome and by-products of the Republican AHCA 2.0 that we should use our own knowledge and common sense.

As you read here a couple weeks ago, the CBO projection that the House version of the AHCA 2.0 would result in 24 to 26 million fewer people with coverage is baloney. Yet, that is what the Press will run with day after day. It’s probably good for their advertising rates on the networks and papers to support dire predictions even when they are knowingly false.

Some are reporting that the Senate is working toward a vote on its version of the AHCA 2.0 before the end of June. No one has seen its language but I won’t bet against its probability.
Let’s just remember that as Nay-Sayers make their doom-n-gloom, old people and babies are going to die predictions, that we must not fall victim as so many did in 2010.

I liked the idea of keeping the plan I had with the doctor I had and premiums going down, didn’t you. But, we knew then it was baloney so don’t listen to the opponents of AHCA 2.0 without a healthy dose of common sense. Sorry for the dopey metaphor.

Hey, projections by the Government are like the statement President Reagan made 30+ years ago. What we need is for the Government to do is get the heck out of the way.

Anyway, we’ll see how it goes because we are all in this together!
Until next week.

Mark Reynolds, RHU



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