Under current Centers for Medicare and Medicaid rules, states cannot charge Medicaid recipients more than $8 for non-emergency trips to a hospital emergency room.
For inpatient care, states can charge patients as much as half the cost for their first day of treatment, or set a nominal fee. For outpatient care, states only can charge a $4 co-pay if patients' income is below the federal poverty line.
That doesn't seem like much, but state Sen. Evan Jenkins, D-Cabell, said studies have proven even small co-payments encourage health care consumers to reconsider unnecessary medical services.
Jenkins also serves as executive director of the West Virginia State Medical Association.
"With a little financial skin in the game, they will think about that co-pay when deciding whether or not 'I really need to go to the doctor,' " he said. "When something is free, we don't place a very high value on it. We may take it for granted and we may over-utilize."
And that is exactly what is happening at hospitals around the state.
Dale Wood, chief quality officer for Charleston Area Medical Center, said most people who arrive at emergency rooms are soon sent back home.
"Depending on the type of hospital, it may be as high as 80 percent go home," he said.
Sometimes, that makes sense. Patients might require a specific medical test, which emergency rooms can perform with very short turnaround times. Other times, patients might not know the severity of their condition and go to the ER out of an abundance of caution.
"But then another fairly large percentage of those who go home probably could have been seen by their primary care physician," Wood said.
Many patients without insurance rely on hospital emergency departments for their basic medical needs, since ERs are required by law to provide care for sick people regardless of their ability to pay.
Some Medicaid patients also go to the emergency room any time they have an ailment, no matter how insignificant, since they do not have to pay anything out of pocket for the visit.
Officials hope expanding Medicaid will curb the former type of ER overuse, and co-pays will put an end to the latter variety.
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