The studyauthors speculated that some with private plans were avoiding caredue to high out-of-pocket costs associated with going to thehospital. (Photo: Shutterstock)

A newstudy offers good news and bad news about the Affordable CareAct.

The study by the Urban Institute indicates that those withhealth coverage through the ACA marketplace receive "significantlyless care" in hospital emergency rooms than Medicaid enrollees.That's despite the fact that there is much greater spendingassociated with each visit for those with private ACA plans.

The average spending for a marketplace enrollee is $2,445 "perunit of care," in the ER compared to only $844 for Medicaidenrollees. For outpatient hospital care the disparity is smallerbut nevertheless significant: $522 versus $306.

Related: Medicaid expansion cheaper than ACAsubsidies

The study was based on 2014-16 data from the Medical ExpenditurePanel Survey (MEPS) Household Component.

Perhaps the most striking difference between the two groups ishow much more likely Medicaid enrollees are to visit the ER. Duringthe timeframe that was studied, 23 percent had an ER visit,compared to just over 10 percent of those with private ACAplans.

The study authors speculated that some with private plans wereavoiding care due to high out-of-pocket costs associated with goingto the hospital, including deductibles and copays. Medicaidenrollees typically don't face significant out-of-pocket costs.

The Urban Institute argues that the study underscores thebenefits of expanding Medicaid access, as 38 states have done sincethe ACA offered significant federal funding to states that grantedaccess to everybody below 138 percent of the federal povertylevel.

"Relying more on the ACA marketplace to expand health insurancecoverage could increase total expenditures, given marketplaceenrollees' higher per capita spending across certain services,"says the study. "However, policymakers also need to take otherfactors into account, such as administrative costs, cost-sharing,and network quality, to know whether expanding Medicaid ormarketplace plans is more desirable."

Read more: 

• Medicaid expansion: Strong positive outcomes forstates
• Rise in emergency department visits accompaniesMedicaid expansion
• Medicaid expansion tied to 6 percent decrease inopioid deaths