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Republican criticism of Obamacare may have been overtaken by other talking points -- from the influx of unaccompanied minors at the border to the Internal Revenue Service’s handling of tax-exempt organizations -- but it hasn’t disappeared entirely.
On July 7, 2014, Republican National Committee chairman Reince Priebus sent the following tweet:
"Thanks to #ObamaCare, average E.R. wait in California is 5 hours: http://gop.cm/6015YqKd And 'it’s only going to get worse.' "
The tweet is based on, and links to, a July 4 report aired on the Fresno, Calif.-based TV station KMPH, a Fox affiliate.
"If you have to go to an emergency room get ready to wait more than five hours," says the Web version of the KMPH report. "Right now, that is the average wait in the state of California. Health experts say you can blame Obamacare and Covered California for that long wait and they say it's only going to get worse. One of the promised benefits of the Affordable Care Act was to reduce the pressure on emergency rooms by expanding Medicaid and giving the poor better access to primary care. But instead, a survey by the American College of Emergency Physicians suggests something else. The organization says President Obama's health care reform actually has had a destructive effect on the nation's emergency rooms." (The version that aired is archived here.)
But when we took a closer look, we found several problems -- including that the alleged 5-hour wait time was measured before the health care law took effect.
What does 'average E.R. wait' mean?
Actually, there isn’t just one definition. A study published in October 2013 by the California HealthCare Foundation offered three different measurements. The one Priebus references is "patient arrival to being admitted to hospital as inpatient." For California, this wait was five hours and 26 minutes -- longer than the national average of four hours and 34 minutes.
But this is by far the longest of the three measures. The second longest is "patient arrival to emergency room departure for discharged patients" -- basically, the entire length of the visit for someone who isn’t actually admitted as an inpatient after being seen by the E.R. For Californians, this wait time was two hours and 49 minutes, once again a bit higher than the national average of two hours and 19 minutes.
The third measurement is by far the shortest -- "patient arrival to being seen by health care professional." In California, this was 31 minutes, slightly more than the national average of 29 minutes.
One might take away from Priebus’ tweet that someone going to a California E.R. can expect a wait of more than five hours just to get in to see a doctor or a nurse. In reality, they’re seeing a health professional in about a half an hour -- and if their injury or illness isn’t serious enough to keep them in the hospital overnight, then they’re on their way home in under three hours. For those patients, their entire visit is much shorter than the five hours Priebus indicates.
Steven Birenbaum, a spokesman for the California HealthCare Foundation, said the wait time to see a health professional -- the shortest of the three measures -- is actually the most useful statistic in this context, because the longer figure "mainly reflects the inpatient service and how full the hospitals is."
Julie Lloyd, a spokeswoman for the American College of Emergency Physicians, said there’s no "definitive answer" on which measurement is better. Her group focuses more on the wait time to admission or discharge, but she said hospitals market themselves based on wait time to see a doctor. The wait time to see a doctor is likely more familiar to ordinary Americans.
Are long E.R. waits really due to Obamacare?
At this point, any link between the Affordable Care Act and longer E.R. waiting times is speculative at best, because post-ACA data on wait times do not yet exist.
The data from the California HealthCare Foundation is from 2012 -- in other words, long before provisions of the law began taking effect on Jan. 1, 2014. "It is too early to confirm that wait times are increasing under the ACA, due to the delay in data being released," Birenbaum said.
Indeed, E.R. wait times "have been a serious problem for many years," said Lloyd of the emergency physicians’ group. "This is not anything new. It is often incorrectly blamed on nonurgent patients, who only comprise 7 percent to 8 percent of all E.R. patients."
The real reasons for long wait times, Lloyd said, include "increasingly complex workups for patients, particularly older patients with multiple health problems, and the hospital practice of ‘boarding.’ ‘Boarding’ occurs when a patient admitted to the hospital from the E.R. is held in the E.R. while waiting for an inpatient bed. That ties up a bed and physicians’ attention, preventing them from getting to the next patients in line. Some patients are boarded for many, many hours."
This doesn’t mean there’s no support at all for the notion that the ACA has complicated matters for emergency rooms. An online survey of 1,845 emergency physicians, conducted in April 2014 by the American College of Emergency Physicians, found evidence that caseloads had increased since the start of Obamacare -- though even here, the results were mixed. The TV report that Priebus linked to cited this recent survey.
When asked whether the volume of emergency patients in their own E.R. had changed since Jan. 1, 2014, 9 percent said it had increased greatly and 37 percent said it had increased slightly. However, a larger percentage said it had remained the same (27 percent), decreased slightly (20 percent) or decreased greatly (3 percent).
And while 86 percent of emergency physicians said they expected to see an increase in emergency visits over the next three years, it’s not clear that the ACA will be the dominant -- or even a significant -- reason for this. When asked what type of long-term impact the Affordable Care Act will have on access to emergency care, "positive" (34 percent) outweighed "negative" (29 percent), with another 29 percent saying it would have no impact.
It’s also worth noting that the survey data -- the only post-ACA data we have -- speaks to patient volume in emergency rooms. It doesn’t speak to wait times, which was the focus of both the KMPH report and Priebus’ tweet.
Kirsten Kukowski, a spokeswoman for the Republican National Committee, stood by the KMPH story the tweet cited. "If you have to go to an emergency room, get ready to wait more than five hours," she said. "Right now, that is the average wait in the state of California. Health experts say you can blame Obamacare and Covered California for that long wait and they say it's only going to get worse."
KMPH did not return an inquiry for this article. But Birenbaum of the California HealthCare Foundation added a footnote: The San Joaquin Valley, where the TV segment was reported, "has one of the lowest rates of primary care physicians to population. It would make sense that patients often end up" in the E.R.
In a tweet, Priebus said, "Thanks to #ObamaCare, average E.R. wait in California is 5 hours."
The statistic was based on data from 2012 -- two years before the provisions of the ACA could have had any impact. Meanwhile, the five-hour figure is just one of three measurements of E.R. wait times -- and not even necessarily the best one. If you count from the time of a patient's arrival to being seen by a health care professional, the wait time was 31 minutes in California. Even the strongest support for the claim is far from solid: A survey of emergency physicians found signs that E.R. traffic had increased since the ACA took effect in January, but the results were mixed, and this documents patient volume, not wait times. We rate the claim False.
Reince Priebus, tweet, July 7, 2014
KMPH-TV, "Special Report: Obamacare Causing Crowded Emergency Rooms," July 4, 2014
California HealthCare Foundation, California Health Care Almanac, October 2013
American College of Emergency Physicians, "ER Visits Up Since Implementation of Affordable Care Act; Nearly 9 in 10 ER Docs Report Psych Patients Being Held in Their ERs," May 21, 2014
Email interview with Steven Birenbaum, spokesman for the California HealthCare Foundation,
Email interview with Julie Lloyd, spokeswoman for the American College of Emergency Physicians, July 8, 2014
Email interview with Kirsten Kukowski, spokeswoman for the Republican National Committee, July 7, 2014
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