It wasn't supposed to work this way, but since the Affordable Care Act took effect in January, Norton Hospital has seen its packed emergency room become even more crowded, with about 100 more patients a month.
That 12 percent spike in the number of patients — many of whom aren't actually facing true emergencies — is spurring the hospital to convert a waiting room into more exam rooms.
"We're seeing patients who probably should be seen at our (immediate-care centers)," said Lewis Perkins, the hospital's vice president of patient care and chief nursing officer. "And we're seeing this across the system."
That's just the opposite of what many people expected under Obamacare, particularly because one of the goals of health reform was to reduce pressure on emergency rooms by expanding Medicaid and giving poor people better access to primary care.
Instead, many hospitals in Kentucky and across the nation are seeing a surge of those newly insured Medicaid patients walking into emergency rooms.
Nationally, nearly half of ER doctors responding to a recent poll by the American College of Emergency Physicians said they've seen more visits since Jan. 1, and nearly nine in 10 expect those visits to rise in the next three years. Mike Rust, president of the Kentucky Hospital Association, said members statewide describe the same trend.
Experts cite many reasons: A longstanding shortage of primary-care doctors leaves too few to handle all the newly insured patients. Some doctors won't accept Medicaid. And poor people often can't take time from work when most primary care offices are open, while ERs operate round-the-clock and by law must at least stabilize patients.
Plus, some patients who have been uninsured for years don't have regular doctors and are accustomed to using ERs, even though it is much more expensive. Others have let illnesses and injuries fester so long they have become emergencies.
"It's a perfect storm here," said Dr. Ryan Stanton of Lexington, president of the Kentucky chapter of the ER physician group."We've given people an ATM card in a town with no ATMs."
Richard Roberts, a 58-year-old Louisville resident who received expanded Medicaid through the ACA a couple of months ago, spent about 31/2 hours in Norton's ER this week, where he got a brace for a dislocated knee. The unemployed former highway worker said he was uninsured for about three years, has no regular doctor and went to the ER because it has the X-rays and scanning equipment to diagnose him.
Roberts said he's also gone to the ER for pneumonia and heat stroke, and would go again if needed. But he also plans to begin looking for a primary-care doctor for regular checkups and routine care. "That's what I'm pushing for," he said.
Hospital officials said they are helping patients find primary-care physicians and hope that helps eventually lessen ER visits.
But in the meantime, they said, crowding and wait times may increase for everyone, and Medicaid costs will be harder to control. A report from the Robert Wood Johnson Foundation said the average ER visit costs $580 more than a trip to the doctor's office.
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