• Posted March 19, 2025

Low-Income Folks Avoiding The ER Post-Pandemic

Poor families have continued to avoid going to the emergency room post-pandemic, even as ER numbers bounced back for folks who are better-off, a new study says.

During the pandemic, visits to ERs for emergency care dropped by about 30% as lockdowns and fears over COVID-19 infection caused the sick and injured to stay away, researchers said.

These emergency visits, called “non-avoidable” by researchers, rebounded to about 95% of expected rates by the end of the pandemic.

But this rebound did not occur among people covered by Medicaid, according to the new study.

ER visits for emergency care generally have remained at 75% of expected rates among people on Medicaid, the federal/state public insurance program for low-income and disabled folks, researchers reported in the March issue of the journal Health Affairs.

“Medicaid and dual-eligible patients — who are often socioeconomically disadvantaged — may be forgoing necessary high-acuity care,” or emergency care for severe illness or injury, said lead researcher Dr. Richard Leuchter, an assistant professor at the David Geffen School of Medicine at UCLA.

“This disparity, exposed by the COVID-19 pandemic, underscores yet another vulnerability in the U.S. healthcare system,” Leuchter added in a news release.

Analysis of 15.6 million ER visits between 2018 and 2022 using a health care actuarial database revealed that emergency care remains lower among people covered by Medicaid, compared to those with private insurance or Medicare, researchers said.

The findings run counter to what researchers had expected, as they thought Medicaid patients would have become more reliant on the ER during the pandemic for needed health care.

It might be that poorer families avoided the ER during the pandemic because they share their home with older generations more vulnerable to COVID, researchers speculated.

After COVID fears declined, however, people covered by Medicaid did not start going back to the ER for even emergency care, results show.

This might be due to the closure of hospitals that serve more vulnerable patients, making it harder for them to get to an ER, researchers said.

It also might be that poor people covered by Medicaid are choosing to prioritize staying on the job to seeking emergency care at an ER.

Finally, policies meant to keep people from visiting the ER for care they can get at a doctor’s office might be dissuading Medicaid patients from going to the hospital for emergency care, researchers said.

“There is precedent for state Medicaid programs attempting to either deny payment or increase copays for avoidable ED visits, and already one major U.S. private insurer has attempted to deny coverage for potentially avoidable ED visits in the wake of the COVID-19 pandemic,” researchers concluded.

More information

The National Institutes of Health has more on when to use the emergency room.

SOURCES: UCLA, news release, March 11, 2025; Health Affairs, March 2025