State plan to limit unnecessary ER visits is sound

Although, the list of nonemergency conditions Medicaid wouldn't cover needs to be reviewed.


Social services, and health care in particular, are at the root of the state's budget troubles.

Spending for social services would increase about 13 percent over the next two years in the budgets proposed by the House and Senate. And that increase will likely occur even though the Legislature must make massive spending cuts to bridge the $5.1 billion gap between projected revenue and projected expenses.

Given that, it's hardly a surprise lawmakers and state officials are desperately looking for ways to reduce the state's health-care costs.

The state has proposed limiting nonemergency visits to the ER to three per year for those with taxpayer-subsidized Medicaid health-care insurance. By limiting access to emergency rooms for this nonemergency conditions, the state estimates it could save between $72 million and $76 million over the next two years. That's a lot of money that could be used for education and other state services.

We believe the state is on the right track. Unnecessary trips to the ER are a drain on the nation's health-care resources.

But getting this problem under control on a national or state level is difficult. Denying people access to life-saving health care is something we, as a nation, simply do not do.

This is why the law mandates nobody can be denied treatment at an ER. It applies to all - regardless of ability to pay or citizenship status.

Unfortunately, the system is being abused. People who have no health insurance too often use the ER room for services that would be far cheaper at a walk-in clinic. Of course, they would have to pay something at the clinic and zero at the ER.

Surely some common sense can be infused into this issue, right?

The state's approach is now coming under fire as this plan could put the health of children at risk. The Seattle Times reported critics have concerns over some of the conditions listed as nonemergency.

At the heart of their criticism was a fear parents and patients might self-diagnose and make bad choices. They said the long list of nonemergency conditions included such things as hypoglycemic coma or asthma attacks goes too far, The Times reported.

And, Dr. Tony Woodward, emergency-services medical director for Seattle Children's hospital, said parents working long or odd hours are forced to get care at the ER.

But those with Medicaid aren't the only folks who find it a challenge to get to a doctor's office or clinic because of work or other constraints. Yet, those whose insurance carrier forces them to pay a lot more for ER visits than office visits seem to find a way to make it work more often than not.

Perhaps the list of nonemergency conditions needs to be reworked by medical professionals to greatly reduce the chance of serious harm or death.

This plan is clearly not perfect, but the basic principle is sound. Capping at three nonemergency ER visits a year is hardly draconian and is prudent public policy.


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