Public Release: 

Young people after Obamacare: Some ER visits down, others way up

American College of Emergency Physicians

WASHINGTON --While emergency department visits for young adults ages 19 to 25 decreased slightly overall following the implementation of the Affordable Care Act (ACA), visits for mental illnesses in this age group increased "significantly," as did diseases of the circulatory system, according to a study published online this month in Annals of Emergency Medicine ("Relationship of ACA Implementation to Emergency Department Utilization Among Young Adults').

"Increased health insurance coverage reduced ER visits by young people for conditions that can be treated in office-based settings, but the lack of mental health resources continues to bring these patients to the ER in ever larger numbers," said study author Renee Hsia, MD, of the University of California San Francisco. "We also saw an increase in patients with diseases of the circulatory system, such as non-specific chest pain. There was a big decrease in ER visits for complications of pregnancy among young people, which is important as it was among the top reasons they visited the emergency department prior to the implementation of the ACA."

Researchers conducted a before and after study of patient visits to emergency departments in California, Florida and New York to determine whether the ACA had an impact on those visits. Patients age 19 to 25 were compared to patients 26 to31 over the same time periods (September 2009 through August 2010 versus January through December 2011).

After the implementation of the ACA, the rate of emergency department visits by young people decreased by 0.5 percent. However, the relative risk of a young adult ever to visit the emergency department increased by 2.6 percent for mental illness and by 4.8 percent for diseases of the circulatory system (e.g. cardiac dysrhythmias). The relative rate of emergency department visits decreased by 3.7 percent for pregnancy-related diagnoses and by 3.3 percent for diseases of the skin (e.g. cellulitis and abscesses). The decreases in emergency department visits were seen almost exclusively among white and black young adults, not Hispanics.

"The troubling finding is that young adults were more likely to visit the emergency department for mental illnesses following expanded insurance coverage under the ACA," said Dr. Hsia. "Significant barriers to care for mental health issues persist, leaving these patients little choice but to seek care in the only place they know they can get it: the ER."

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Annals of Emergency Medicine is the peer-reviewed scientific journal for the American College of Emergency Physicians, the national medical society representing emergency medicine. ACEP is committed to advancing emergency care through continuing education, research, and public education. Headquartered in Dallas, Texas, ACEP has 53 chapters representing each state, as well as Puerto Rico and the District of Columbia. A Government Services Chapter represents emergency physicians employed by military branches and other government agencies. For more information, visit http://www.acep.org.

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