Last week, Mississippi Governor and potential presidential candidate Haley Barbour (R) — who vigorously opposes expanding the state’s Medicaid program — tried to minimize his state’s health care access crisis by arguing, “There’s nobody in Mississippi who does not have access to health care.” Barbour maintained that hospitals and doctors routinely provide charitable care and said that residents without reliable access to health insurance received care from clinics.
Barbour may be technically correct — the 1986 Emergency Medical Treatment and Active Labor Act requires hospitals to treat emergency conditions — but as Aaron Carroll and Austin Frakt of the Incidental Economist point out, the emergency room is not a good place for patients with chronic conditions:
Over 25 million people in the United States have diabetes, requiring regular access to medication to stay alive. They can’t get insulin in an emergency room. They can’t get needed eye exams or kidney function tests in the emergency room. They can’t get a checkup in the emergency room. But once they go into hypoglycemic shock or once their feet become gangrenous, then they can get examined and treated. Does that sound like access to health care?
About 20 million people in the United States have asthma. They can’t get their prescription refills in an emergency room. They can’t get the equipment then need, like nebulizers or inhalers or spacers in an emergency room. They also can’t get checkups in an emergency room. Once they have an attack so bad that they could die they can get examined and treated, but that’s not access to health care.
Over 200,000 women were diagnosed with breast cancer in 2010. Not a single one of them could get a mammogram in an emergency room. Over 140,000 people were diagnosed with colorectal cancer in 2010. Not a single one of them could get a colonoscopy in the emergency room.
Nearly one in 100 children have Autism, and not a single one of them can get any treatment at all in the emergency room. More than 5 million children have attention deficit hyperactivity disorder (ADHD), and not a single one of them can get any treatment at all in the emergency room. Around ten percent of all children may qualify for interventions for developmental delay, but few get them, and not a single one of them get them from an emergency department.
Americans often think of health care as acute care — you have a condition that requires emergency surgery, so you go into one of the country’s state-of-the-art health centers and undergo the needed procedure. Most of health care is far more simple. It’s not about complex surgery or fancy technology: it’s about keeping patients healthy, managing their chronic conditions so they don’t worsen, and preventing them from needing that surgery in the first place.
You can’t find that kind of care in an emergency room, particularly when the availability of good emergency room care is in decline. In 2006, 119 million visits were made to ERs, up from 90 million in 1996. At the same time, the number of hospital ERs dropped to fewer than 4,600, from nearly 4,900, causing wait times to also increase.