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Republican presidential candidate Carly Fiorina appears on CNN's "State of the Union" (screenshot). Republican presidential candidate Carly Fiorina appears on CNN's "State of the Union" (screenshot).

Republican presidential candidate Carly Fiorina appears on CNN's "State of the Union" (screenshot).

Louis Jacobson
By Louis Jacobson August 10, 2015

Carly Fiorina says emergency room visits are up 50 percent under Obamacare

The Affordable Care Act, President Barack Obama’s signature health care law, may have been signed in 2010, but it continues to shape the 2016 Republican presidential campaign.

Carly Fiorina -- fresh off what many commentators considered a strong debate performance on Aug. 6 -- discussed her opposition to the health care law in an interview with host Jake Tapper on CNN’s State of the Union.

Tapper noted that Fiorina is a breast cancer survivor, "and we're all very grateful for that. Didn't your experience show you that the pre-existing condition part of Obamacare is crucial, that there are so many people out there like you, but without your means, who wouldn't be alive if it were not for the part of the law that says, insurance companies have to take on people with pre-existing conditions?"

Fiorina responded, "I absolutely endorse that goal. I did at the time. But guess what? None of that has worked. Demonstrably, if you look at the results of Obamacare, what you see is emergency room visits are up over 50 percent."

A reader asked us to check whether this is correct, so we took a look. The Fiorina camp didn’t respond to inquiries.

A look at a recent survey

Reducing the influx of patients in emergency rooms was always a significant goal of the Affordable Care Act. Because hospitals by law cannot refuse emergency care, uninsured patients may be left with no option beyond the E.R. even to treat minor health issues. Yet this is an expensive solution for the health care system, since E.R. care costs much more than routine medical care dispensed by general practitioners. By increasing insurance coverage, the thinking went, patients would be steered toward providers who charge less than emergency rooms, saving money for insurers and, ultimately, for patients and taxpayers.

So has it worked?

The official statistics on emergency-room visits are published on an annual basis by the Centers for Disease Control and Prevention. However, the most recent report -- released in 2014 -- covers 2011, which was well before most elements of the health care law kicked in. So that data set is not helpful in judging the accuracy of Fiorina’s claim.

Failing that, the best data we have comes from a survey conducted by the American College of Emergency Physicians in March 2015.

The most relevant question in that survey was: "Since January 1, 2014, when the requirement to have health coverage took effect in the Affordable Care Act, the volume of emergency patients in my emergency department has … increased greatly? increased slightly? remained the same? decreased slightly? decreased greatly?"

Here’s the breakdown, based on the responses of 2,098 member physicians of the American College of Emergency Physicians:



Percent of surveyed giving this response

Increased greatly

28 percent

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Increased slightly

47 percent

Remained the same

17 percent

Decreased slightly

5 percent

Decreased greatly

0 percent

Not sure

3 percent



The finding that only 5 percent of respondents saw any decrease in patients in their emergency room provides some validation for Fiorina’s claim. If this is a valid finding, then the health care law isn’t only failing at one of its main missions, but it’s actually making things quite a bit worse.

But Fiorina seems to have garbled her talking point. Fiorina said emergency room visits "are up over 50 percent" -- not that a majority of emergency room doctors say they are seeing more patients come for treatment.

In reality, the survey does not offer specifics on how many more visits there have been after implementation of the law. And a plurality of respondents suggest that the increases they’ve seen are "slight," which doesn’t sound like a word most people would use to describe a 50-percent increase.

Another concern: The American College of Emergency Physicians, as the sponsor of a survey, is not a neutral party in the same way a media pollster is. Also, the survey is what is known as an "opt-in survey." Unlike a poll in which the survey company reaches out to a random selection of the desired population, the emergency physicians’ poll is one in which individual respondents have chosen whether or not to participate.

Still, the point Fiorina raises is a concern among health-care policy specialists. The magazine Health Affairs noted in July that between 1992 and 2012 the number of patient visits to hospital emergency rooms has risen 47 percent -- from 91 million to 133 million -- even as the number of facilities serving them fell by 11 percent, from 5,035 to 4,460. Given this, 39 percent of E.R.s report daily overcrowding. Again, though, this data is from before the law fully went into effect.

Such figures suggest a problem many years in the making, but there’s also concern that the Affordable Care Act specifically has made the problem worse. One theory is that insurance rates have increased faster than the number of doctors available to serve the newly insured patients. This may have led some newly insured patients to fall back on old habits and make the E.R. their first option even for non-emergency care.

Our ruling

Fiorina said, "If you look at the results of Obamacare, what you see is emergency room visits are up over 50 percent."

Fiorina has raised a legitimate concern about the health care law, but the eye-popping statistic she cites is not supported either by official federal data or by a recent survey of members of the American College of Emergency Physicians. We rate her claim Mostly False.

Our Sources

Carly Fiorina, comments on CNN’s State of the Union, Aug. 9, 2015

American College of Emergency Physicians, 2015 ACEP Poll Results, March 2015

Centers for Disease Control and Prevention, "National Hospital Ambulatory Medical Care Survey," 2014

Health Affairs, "Assuring Hospital Emergency Care Without Crippling Competition," July 6, 2015

Huffington Post, "ER Visits Jump As Obamacare Kicks In, Doctors Say," May 21, 2014

Email interview with Charles Franklin, director of the Marquette Law School Poll, Aug. 10, 2015

Email interview with Mike Baldyga, spokesman for the American College of Emergency Physicians, Aug. 10, 2015

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Carly Fiorina says emergency room visits are up 50 percent under Obamacare

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