Limiting ER Medicaid Patient ER Visits: A Way to Curb ER Overcrowding, or a Dangerous Limitation of Access to Medical Care

Washington State has approximately 1.1 million of their residents covered by Medicaid and two thirds of these are children.  In 2003, President Bush passed a law allowing states to limit access to ER's for Medicaid patients.  Since then, a few states have enacted such laws.    In an effort to lower the cost of health care, Washington State is proposing limiting the amount of ER visits Medicaid patients can make in a year.  They plan to only allow for three “non-emergency” visits per year.  If the patient makes more than three visits, the state will not pay the hospital for any services provided for after the third visit.  They estimate that the can save up to seventy-six million dollars over two years. 

They have a fifteen page list of nonemergency conditions.  However, some of the conditions they include as non-emergent include hypoglycemic coma, asthma attacks, abdominal pain, some types of bleeding and other potentially dangerous medical conditions.     Crises from chronic conditions like Sickle Cell anemia are included in the list as well. The person that developed this list is not a physician, and said the list was not intended to be used to make health care decisions or payments.  In fact, he has stated that the list was actually created to help officials find out where patients have trouble accessing primary care and help figure out if particular programs work well. 

It is extremely dangerous to place these limits on patients.  It may deter a patient bringing their child in with an asthma attack, because it is going to be labeled as non-emergent.  This can cause many deaths.  Even things that are truly non-emergent, can become emergent.  For patient that needs a medication refill or has lost their prescription, and cannot get an appointment with a doctor to get a, sometimes going to the ER is their only solution to get access to potentially life-saving medication.  Although ER overcrowding is a problem, deterring patients from seeking medical care is not a proper solution to this problem. 

Anyone else have a problem wtih this?  What do you think?