The Affordable Care Act (ACA) has helped thousands of Americans obtain healthcare, especially minorities and those in low-income areas. But what is the impact of the ACA on usage of eye-related emergency department (ED) services?

In a study presented this week at ARVO’s virtual 2021 conference, researchers took data from the US Nationwide Emergency Department Sample and analyzed nearly 17 million eye-related ED visits before the ACA was implemented (8.1 million between 2010 and 2013) and after the ACA was enacted (8.7 million between 2014 and 2017). The primary outcome was to compare the nationwide and regional incidence of eye-related ED visits per 100,000 people before and after the ACA. Secondary outcomes measures included change in payer status, relative proportion of urgent vs. non-urgent eye-related ED visits and charges per ED visit.

After the ACA was mandated in 2014, there was an initial decline in incidence of eye-related ED visits, from 652.4 per 100,000 in 2013 to 593 per 100,000 in 2014, followed by a rapid increase in incidence (658.5 per 100,000 in 2015) and another increase (to 746.6 per 100,000) in 2016. The percentage of uninsured patients decreased from 19% to 14.3% and those with Medicaid coverage increased from 29.4% to 36%. The increase in ED utilization was greatest for individuals belonging to the lowest income quartile.

However, overall, only 38.3% of the ED visits during the study period were due to emergent eye conditions. The inflation-adjusted median charge per ED visit increased from $718.40 to $999.50 after the ACA was put in place.

The authors note that emergency department utilization for non-emergent ophthalmic conditions continues to increase, resulting in more costly and less specialized care. Additional measures beyond expanding insurance coverage may be necessary to provide high quality, efficient and equitable healthcare to all Americans.