A new study in the Journal of the American Medical Association found that emergency visit rates have increased at twice the rate of growth of the U.S. population from 1997 to 2007; Medicaid patients accounted for a large proportion of the increase, often coming with more severe illnesses and complications.

Nearly two-thirds of emergency departments were classified as safety net hospitals in 2007 — defined as providing a "disproportionate share of services to Medicaid and uninsured patients" — which is nearly double the number classified as such in 1997.

Study authors also acknowledge that significant changes have occurred in America since 2007, which likely will affect future results, including a severe recession that started in 2008, record job losses in 2008 and 2009, an estimated 5.8 million Americans becoming uninsured and another estimated 5.4 million enrolling in Medicaid and the State Children's Health Insurance Program (SCHIP).

"Emergency departments provide a health care safety net for everyone, not just the uninsured," said Dr. Angela Gardner, president of the American College of Emergency Physicians. "But Medicaid pays so poorly in many states that physicians limit the number of Medicaid patients they will see. When these patients get sick but can't get in to see a physician, they often wait until an illness has worsened to the point that they need care in an emergency department. This is important to remember, especially as the nation implements the new health care reform law. Health plans must provide fair payment for services, or patients will suffer."

According to the report, the increase in emergency visits is almost double what would be expected from population growth during this period. In addition, the number of emergency departments has decreased from 4114 emergency departments in 1997 to 3925 in 2007.

"Decreasing reimbursements for emergency care and growing levels of uncompensated care related to caring for millions of uninsured patients have contributed to the closure of hundreds of emergency departments across the country and a lack of emergency resources," said Dr. Gardner. "This limits everyone's access to lifesaving emergency care. ERs are a critical, life or death part of our health care system that need help now. The crisis in emergency care is everyone's problem, because we are all only one step away from a medical emergency."