One of the big arguments for expanding the Medicaid program in Missouri has been the notion that by doing so, wasteful emergency room use would decline. In fact, Missouri Gov. Jay Nixon released a statement on New Year's Eve that suggested this precisely (emphasis mine):

Tomorrow, businesses in these states [that expand Medicaid] will have a significant competitive advantage – because as more people get health coverage, fewer people show up in emergency rooms, putting downward pressure on private health premiums.

But a "gold standard" study out of Oregon — released just two days after the governor's statement — suggests that's not true: that rather than decrease emergency room usage, a Medicaid expansion may actually make the problem worse. (Emphasis mine.)

Writing in Science, the Oregon Health Insurance Experiment researchers found that Medicaid did increase the use of preventive and primary-care services, but emergency-room use rose as well. Over an 18-month period, 100 low-income, uninsured adults in the Portland area would visit the ER about once each, on average. When Medicaid made health care "free" [for] these households, they made an additional 40 visits over that period — a 40-percent increase.

The increase was entirely comprised of people using the ER either for non-emergency medical needs, or for emergencies that could have been prevented with primary care. "Emergency department use increases even in classes of visits that might be most substitutable for other outpatient care," the authors wrote, "such as those during standard hours (on-hours) and those for 'non-emergent' and 'primary care treatable' conditions."

It's irresponsible to expand a broken Medicaid program. That irresponsibility is accentuated when expansion proponents push arguments — like, "Medicaid reduces emergency room use" — that tend to fall apart when investigated. We all agree that Medicaid is in dire need of reform. It would be nice for policymakers to start recognizing reform as its own, superseding good, rather than just as a convenient rhetorical tool with which to repackage a Medicaid expansion.