The White House’s health reform plan is supposed to take the burden off of emergency rooms. Most people will have health insurance and see their own doctor, rather than waiting until they are so sick they need very expensive ER care. That’s the theory, anyway.
A Colorado ER doctor takes issue with the theory, though.  In research published in a medical journal today, he says the federal health care law is going to make emergency rooms more crowded, not less.

CPR HEALTH REPORTER ERIC WHITNEY: The University of Colorado’s Dr. Adit Ginde says The Affordable Care Act passed last year may require nearly all Americans to have health insurance starting in 2014, but he says that doesn’t mean they won’t wind up in emergency rooms when a regular doctor visit would do.

CU SCHOOL OF MEDICINE PROFESSOR DR. ADIT GINDE : People may have insurance, and may have primary care doctors, but they may have trouble accessing those primary care services.

WHITNEY: Ginde often sees people in the emergency room who have insurance and a regular doctor, and they tell him their doctors are really busy. Sometimes they can't get an appointment for two weeks or more. So if someone with heart disease is having chest pains, they either go to the ER on their own, or are are told to go there by their overbooked doctor's office.

GINDE: You know, in the press sometimes, patients themselves are blamed for, quote, inappropriate utilization of the emergency department, but a lot of patients are actually trying to get into their primary care offices, and just can't.

WHITNEY: Ginde has looked beyond his personal experience. He’s a CU medical school professor, and co-authored a study being published today that he says confirms his conclusions. Ginde looked at a big national sample of ER patients, and found that, over the last 10 years, more of them are reporting more barriers to an appointment with their family doctors. Barriers often boil down to primary care doctors just being too busy. He says that contributed to roughly a 20% jump in ER use over the same period.
The root of the problem, Dr. Ginde says, is that there simply aren't enough primary care providers.

GINDE: Its important to increase the primary care supply, increase the availability of primary care.

WHITNEY: That means training more primary care doctors, but also using more mid-level providers, like nurse practitioners and physician assistants, Ginde says. It’s especially important with millions more Americans getting health coverage in 2014.
But others disagree with Dr. Ginde's conclusion that the federal health law will mean more crowding in ERs.

GOVERNOR'S SENIOR HEALTH POLICY ANALYST LOREZ MEINHOLD: I think it's not looking at all the different parts of the Affordable Care Act.

WHITNEY: Lorez Meinhold, one of Governor Hickenlooper's top health advisers, is a big supporter of the Affordable Care Act. She says its architects took measures to address the shortage of primary care providers. For instance, the Affordable Care Act gave states grants to study their health care workforce needs. Colorado got $150,000. And, Meinhold says, state policy makers are working on the problem, too.

MEINHOLD: We passed legislation in '09, '10 and '11 to address primary care provider shortages. We've already, because of those changes, leveraged private funding, as well as some of the federal funding that's brought almost $15 million into the state, just in student loan repayment.

WHITNEY: That means Colorado has $15 million to lure new doctors and other providers to the places they're needed most. They get the money only if they do primary care in places where there's not enough.

The state will know more about whether it can meet the steep rise in demand for health care projected in 2014 when it finishes its health care work force study in a month or two.
Jeff Bontrager, at the non-partisan Colorado Health Institute says there's still time to take more action if necessary.

COLORADO HEALTH INSTITUTE RESEARCHER JEFF: BONTRAGER: We are at point where we can take a look at what might be the increased demand among the newly-insured and how the use of health care is going to increase, or the demand for primary care services is going to increase.

WHITNEY: Whether Colorado’s emergency rooms get even busier in 2014 or not, both sides agree that the state needs a lot more primary care doctors and nurses on the job between now and then.

[Photo: CPR/Eric Whitney]