Ambulance rides surged by 37% among city-dwellers after the Medicaid expansion, study finds

Unnecessary ambulance rides surged in New York City after government-subsidized insurance was expanded under the Affordable Care Act, according to a new study. 

Rides for minor injuries increased by over 37 percent once more people became eligible for government subsidized healthcare, University of Colorado (CU Denver) researchers report. 

Public health experts expected to see more people utilize health services after the expansion – but say the intent of the measure was not for people to use more emergency services. 

An ambulance ride costs a patient only $3 in New York City, but ambulance services are expensive and may become an overbearing burden on government healthcare costs, the authors suggest. 

New York City doctors, however, argue that the increase shows the program is meeting the needs of low-income New Yorkers who don’t have cars to drive themselves to the hospital.

And, to their minds, overuse of ambulance services is a small price to pay for people to get medical treatment.   

Since Medicaid was expanded by the Affordable Care Act, in 2014, the number of New York City residents using ambulances has increased by 37%, a graph from the new study shows 

Former President Obama’s Patient Protection and Affordable Care Act came into effect in January of 2014, and included funding to support more people on Medicaid, the government-subsidized insurance program for low-income Americans. 

Across the country, insurance enrollment has since increased by over 27 percent. 

States are allowed to choose whether to opt into the expansion, and New York did so right away. 

Since the state expanded Medicaid, enrollment has grown by 14 percent (as of the latest data, updated in July of last year). 

The proportion of New York City residents without insurance has steadily declined since 2014, and is predicted to fall to under 9.5 percent of the city population this year. 

Medicaid covers inpatient and outpatient treatment, preventive and annual wellness care, screening and, indeed, transportation. 

For those without insurance or even those with private insurance, which often does not cover ambulance transportation, getting to the hospital can be extremely expensive. 

An ambulance costs on average $400 to $1,200 at baseline, with a per mile cost tacked on, according to Cost Helper. 

Getting to the hospital is particularly a problem in New York City, where few people – especially those who qualify for Medicaid – have or can afford cars to drive themselves to the hospital.  

Many New York City residents instead resort to taking Uber or Lyft cars to the hospital – a practice a Harvard University study even supported. 

But there’s some debate over what warrants an ambulance ride, and who should bear the cost of getting to a hospital. 

The CU Denver study authors are concerned that ‘increase in ambulance dispatches for minor injuries compared with those for other types of injuries in NYC after the implementation of the ACA in 2014 could have been associated with patients not having to pay full cost,’ they write. 

The authors also worry that because these increases were seen for minor injuries, like ankle sprains, wait times for more pressing medical emergencies may extend, which could endanger lives. 

But in an accompanying editorial, two New York City doctors dissented. 

They note that the increase was significant, but that only one percent of the ambulance dispatches from the time period the researchers looked at – between 2013 and the first half of 2016 – were for ‘minor injuries.’ 

‘Moreover, evidence exists that while cost sharing can be effective as a means of reducing health care costs, it does so at the expense of both necessary and unnecessary care,’ they write. 

‘Patients can be cost conscious but often times at the expense of needed health care services.’

They also underscore the unique circumstances of New York City, where most residents rely on public transportation, which may be to slow or physically impossible for someone with an injury. 

‘Transportation can be a barrier to health care access, and in NYC in particular, lower-income individuals feel an increased burden,’ they write. 

‘Owning a car and having access to affordable parking is not feasible for most (including many physicians), and public transportation is limited. 

‘Some clinics are far from the nearest public transit stops. Subways and buses are often overcrowded and slow, and for patients with debility, these services can feel especially unwelcoming during a time of distress; any alternative to that would certainly seem more enticing.’