NPRI testimony on how Obamacare will increase ER visits

Geoffrey Lawrence

Yesterday, before the Joint Finance Committees, Geoffrey Lawrence, NPRI's deputy policy director, delivered the following testimony on the negative impacts of Obamacare.

Madame Chair and members of the committee, thank you for allowing me to participate today.

I’d like to briefly address an element of the managed care idea for Medicaid. Although NPRI ideally prefers Medicaid benefits to be structured around a consumer-driven health plan such as a Health Opportunity Account, many states have demonstrated a measurable cost savings by structuring those benefits around a managed care program.

However, under the ACA, I don’t believe we can hope that a managed care program will be able to reduce the state’s expenditures on emergent care. Let me provide a cautionary tale from Massachusetts.

According to statistics released by the Massachusetts Division of Health Care Financing and Policy, emergency department visits actually increased by 9 percent in the four years after universal health care was enacted in that state. By all accounts, this occurred because there were not enough providers to handle the additional demand created by thousands of new patients receiving health insurance. Even though these individuals nominally gained insurance, they were not able to obtain access to care, because of the shortage in supply. This led to increased non-price rationing and, as a result, more visits to emergency departments.

This cautionary tale is particularly relevant for Nevada because the rate of physicians per 100,000 in population is significantly lower here than in Massachusetts. According to the latest data from the U.S. Census Bureau, Nevada has 188 physicians per 100,000 in population, whereas Massachusetts has 469 physicians per 100,000 in population — about 2.5 times as many as Nevada.

Thus, we should expect to see the problem of non-price rationing for a limited supply of available health care to be much more pronounced here than was the case in Massachusetts — meaning our emergency rooms could soon become overwhelmed with additional demand. If this comes true, it could be a costly prospect for Nevada.

Geoffrey Lawrence

Geoffrey Lawrence

Director of Research

Geoffrey Lawrence is director of research at Nevada Policy.

Lawrence has broad experience as a financial executive in the public and private sectors and as a think tank analyst. Lawrence has been Chief Financial Officer of several growth-stage and publicly traded manufacturing companies and managed all financial reporting, internal control, and external compliance efforts with regulatory agencies including the U.S. Securities and Exchange Commission.  Lawrence has also served as the senior appointee to the Nevada State Controller’s Office, where he oversaw the state’s external financial reporting, covering nearly $10 billion in annual transactions. During each year of Lawrence’s tenure, the state received the Certificate of Achievement for Excellence in Financial Reporting Award from the Government Finance Officers’ Association.

From 2008 to 2014, Lawrence was director of research and legislative affairs at Nevada Policy and helped the institute develop its platform of ideas to advance and defend a free society.  Lawrence has also written for the Cato Institute and the Heritage Foundation, with particular expertise in state budgets and labor economics.  He was delighted at the opportunity to return to Nevada Policy in 2022 while concurrently serving as research director at the Reason Foundation.

Lawrence holds an M.A. in international economics from American University in Washington, D.C., an M.S. and a B.S. in accounting from Western Governors University, and a B.A. in international relations from the University of North Carolina at Pembroke.  He lives in Las Vegas with his beautiful wife, Jenna, and their two kids, Carson Hayek and Sage Aynne.