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A Project of The Annenberg Public Policy Center

Fiorina’s Unverified ER Stat

Carly Fiorina claims that “emergency room visits are up over 50 percent” under the Affordable Care Act. Her campaign did not respond when we asked where she got that figure, but there is no evidence we could find to support it.

Fiorina, who is running for the Republican nomination to be president, made the claim on CNN’s “State of the Union,” when she was asked about the Affordable Care Act requiring insurance companies to cover people with preexisting conditions. Fiorina said she has endorsed that goal, but she said the law has not worked — including the promise that it would save money by reducing emergency room visits.

Fiorina, Aug. 9: Demonstrably, if you look at the results of Obamacare, what you see is emergency room visits are up over 50 percent.

We asked her campaign for the source of the statistic, but we didn’t get a response.

Data on ER visits is only available through 2011 from the Centers for Disease Control and Prevention and through 2012 from the Department of Health and Human Services’ Healthcare Cost and Utilization Project. That was before much of the law began to take effect, including the requirement, beginning in January 2014, that most individuals obtain health insurance.

Still, the data are instructive.

The CDC estimates that there were 136.3 million ER visits in 2011. The HCUP data place the 2012 estimate at 134.4 million. The methodology is different, so the data sets cannot be compared. However, both show there were more than 130 million ER visits in those years — meaning that in order for Fiorina to be right, there would have to be an increase of more than 65 million ER visits, and the total number of ER visits would have to exceed 195 million.

That’s unlikely.

A 50 percent increase in ER visits in the period since the Affordable Care Act would be huge. ER visits increased 44 percent over a 20-year period, from 1993 (92.6 million) to 2013 (133.6 million), according to American Hospital Association data for community hospitals. That is an average increase of 2.2 percent per year.

Likewise, the HCUP data show ER visits have increased nearly 12 percent over six years, from 2006 (120 million) to 2012 (134.4 million). That’s an average annual increase of 2 percent.

There have been media reports, including in the Wall Street Journal, of an increase in ER visits since January 2014, when people were required under the Affordable Care Act to obtain health insurance. Many of those reports were based on an opt-in survey of members of the American College of Emergency Physicians. The ACEP conducted the survey in March and released the results in May. But it doesn’t support Fiorina’s claim.

The poll found that 75 percent of the 2,099 member physicians who participated in the online survey saw a slight or significant increase in the number of patients visiting their ERs since January 2014.

2015 ACEP Poll, May 4: Since the implementation of the ACA, the majority of member physicians have noticed an increase in the volume of emergency patients. Specifically, 47% of emergency physicians indicate slight increases in the number of patients, while 28% of respondents report significant increases in the number of emergency patients.

But the percentage increase for ER patients was not specified, so all we know is that three-quarters of respondents in an unscientific survey said that there had been an increase, and that nearly half said that the increase had been “slight.”

“I’m not sure where the 50 percent stat comes from,” said Mike Baldyga, ACEP public relations manager, in an email to FactCheck.org.

“It doesn’t mean it’s wrong – it could turn out to be right.” We “just can’t verify it,” he said.

Baldyga said it could be a few years before we have specific figures on ER visits under the Affordable Care Act, since CDC data are usually three years behind. But he said the bottom line is that ER visits “are going up post ACA.”

There is some evidence, however, that the law is slowing the growth of ER visits — at least among the younger adults who, since Sept. 23, 2010, have been permitted under the law to remain on their parents’ policies up to the age of 26.

To test the impact of that provision, researchers at Stanford University compared the relative change in emergency department visits from 2009 to 2011 in three states (California, Florida and New York) among two age groups: those between the ages of 19 and 25 and those between 26 and 31. The study, which was released in 2014, found “a relative increase of 1.5 percent in ED visits by the younger group and a 3.7 percent increase for the older group (Exhibit 3). Because the former had a smaller increase compared to the latter, the difference-in-differences analysis estimated a reduction of 2.1 percent in young adults ages 19–25, compared to people ages 26–31.”

The study concluded: “These results hold out the possibility that in some populations, the net effect of further coverage expansions could be a reduction in ED use.”

It may be years before we know the full impact of the ACA on ER visits. But for now we know that Fiorina’s claim is unsupported by the evidence and unlikely based on historical trends.

— D’Angelo Gore