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Young People After Affordable Care Act: Some ED Visits Down, Others Way Up
While emergency department (ED) visits for young adults aged 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 [ED] 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 [ED] in ever larger numbers," says 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 nonspecific chest pain. There was a big decrease in [ED] 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 EDs in California, Florida, and New York to determine whether the ACA had an impact on those visits. Patients aged 19 to 25 were compared to patients 26 to31 over the same time periods (September 2009 through August 2010 vs. January through December 2011).

After the implementation of the ACA, the rate of ED visits by young people decreased by 0.5%. However, the relative risk of a young adult ever to visit the ED increased by 2.6% for mental illness and by 4.8% for diseases of the circulatory system (eg cardiac dysrhythmias). The relative rate of ED visits decreased by 3.7% for pregnancy-related diagnoses and by 3.3% for diseases of the skin (eg cellulitis and abscesses). The decreases in ED 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 ED for mental illnesses following expanded insurance coverage under the ACA," says 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 [ED]."
Source: American College of Emergency Physicians