Health Policy and Health Services Research
Background: Single payer health care is supported by a majority of Americans, yet its effect on ED reimbursement and consumer costs is understudied.
Methods: To determine the effect of two single payer system variants on reimbursement and out of pocket (OOP) spending for emergency care.
Results: We used the 2013-2016 Medical Expenditure Panel Survey (MEPS) to determine average reimbursements and OOP expenditures for the primary payer for each visit. We excluded ED visits resulting in admission, as ED expenditures are not available. We used the 2015 National Hospital Ambulatory Medical Care Survey (NHAMCS) to determine the distribution of ED visits by primary payer. We modeled two reform scenarios: “Medicare-for-All” and an alternate scenario where Medicaid remained intact for those meeting current eligibility. We applied an empiric range of consumer price elasticities of demand to adjust for utilization changes within a range of cost-sharing requirements. After predicting the expected changes in visits and reimbursement for each payer, we determined the expected change in total ED reimbursement and OOP costs under both reform scenarios
Conclusion: A total of 18,840 ED visits representing 107,924,881 weighted visits were included. The weighted total visits (in millions) included Medicare (14.1), Medicaid (39.5), dual enrolled (3.5), commercial (34.5), other (3.6), and uninsured (12.6). Assuming no changes in reimbursement, a Medicare-for-All scenario would increase total annual reimbursement (in billions) from $101.3 to $114.8 (range $107.1 to $122.5). This is primarily from higher mean payments for visits among those currently with Medicaid or no insurance, which offsets the lower mean payments for the commercially insured. In the combined Medicare/Medicaid scenario, annual reimbursement (in billions) would decline to $96.0 (range $87.1 to $104.8). Average OOP costs were predicted to decrease from $102 per visit to $46 with Medicare only and to $32 with Medicare/Medicaid.
Conclusion: Medicare-for-All may increase ED reimbursement and reduce OOP costs, while preserving Medicaid in a single payer system may reduce ED reimbursement.