WASHINGTON -- People seeking urgent medical care could face longer wait times and other challenges a...

1. U.S. emergency care system gets "D+" in new report
WASHINGTON -- People seeking urgent medical care could face longer wait times and other
challenges as demand increases under Obamacare, U.S. emergency doctors said in a report on
Thursday that gives the nation's emergency infrastructure a near failing grade.
In its latest "report card," the American College of Emergency Physicians said such reduced access
earned the nation a "D+" - that's down from the overall "C-" grade from the group's last report in
2009.
Shortages and reduced hospital capacity make it more difficult to access emergency care, the group
said. It also warned about the impact on disaster preparedness.
While the report does not measure the actual quality of care provided, it does offer a snapshot of
national and state policies affecting emergency medicine as seen by providers.Â
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 Washington, D.C., was ranked the highest in the report, earning a "B-" grade, while Wyoming
ranked last and was the only state to earn an overall failing grade of "F."
The group's task force looked at scores of measure in five major categories - access to care, quality
and patient safety, liability, injury prevention and disaster preparedness - and relied on data from
the Centers for Disease Control and the Centers for Medicare and Medicaid Services, among others.
The report comes just as the Affordable Care Act, also known as Obamacare, comes into full effect
this year. The 2010 law aims to expand access to health insurance and reduce the nation's
healthcare costs, but it has become a political flashpoint amid a troubled rollout of the federal
insurance exchange website.
While the physician's report does not factor in all of the effects of the law - its grades are based on
data from early 2013 - emergency rooms could be used even more as more Americans gain

2. insurance coverage under Obamacare, it said.
Some health experts have predicted that increasing the number of insured patients should reduce
pressure on hospital emergency rooms because access to regular doctor care will improve,
something that is hoped would prevent chronic conditions from spiraling out of control or help catch
other problems before they worsen.
But insurance coverage could also lead those who might have held off going to the emergency room
to seek care, said Jon Mark Hirshon, an emergency medicine doctor and researcher at the University
of Maryland who oversaw the group's report card.
Newly insured people also may have a hard time finding a regular doctor who accepts their plan, he
said.
"On top of that, emergency departments are open 24 hours a day, seven days a week. If I have a
primary care provider but it's 9 o'clock at night on a Friday and they're closed, then people come to
the emergency department," Hirshon told Reuters.
The group is asking for congressional hearings to probe whether the law puts "additional strains" on
emergency rooms.Â
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 Already, beds for patients have fallen from a rate of 358 per 100,000 people four years ago to
about 330 beds per 100,000 people now, the report said. Wait times have increased to a median of
4.5 hours compared to four hours in 2009.
Despite the dismal U.S. grade given by the group, it noted that policies and infrastructure varied
widely by state.
States with the best emergency care include Massachusetts, Maine, Nebraska and Colorado, while
Kentucky, Montana, New Mexico and Arkansas rounded out the bottom, just above Wyoming.

3. States are also still grappling with the uninsured. By law, hospitals must provide emergency care
regardless of patients' ability to pay. Under Obamacare, states can expand access to Medicaid, the
federal-state health insurance plan for the poor.
Data shows that Medicaid patients use emergency rooms as much as other insured patients, but
several recent studies have shown that Medicaid patients utilize them more than the uninsured.
One study this month showed Oregon patients given Medicaid through a lottery increased their
emergency room use by 40 percent compared to those not offered Medicaid.
"We have to be leaner and more efficient, but it just becomes more and more challenging," Hirshon
said.