[quote=no_such_reality]The underlying systemic issue is what is causing our prior model to break. We’re not a heartless nation saying just let people die, so we EMTALA. EMTALA results in 80% of ER visits being uninsured. The ER is one of the LEAST cost effective points for treating people.

….

IMO, the biggest savings of ACA will be driven by taking a large subset of the 40+ million uninsured and moving them from expensive, too little too late treatment in the ER, to less expensive, more preventative treatment up stream.[/quote]The problem is that many of the people who use the ER in this manner are illegal aliens. Mexico does have medical insurance, but it is tiered based upon how much you pay. If a US citizen goes to the ER for treatment, the bill collectors will hound them. They can’t hound an illegal. No SSN, no TIN. nada, nothing. Because of their status, they are harder to track and make pay into the system, or pay for costs they incur. Because of their status, most of them have advanced health problems. Because they are often the lower strata of Mexican society, they also have health problems from poor nutrition.

Take a look at the following:
Illegal immigration by state:
http://www.slate.com/articles/news_and_politics/map_of_the_week/2013/02/map_illegal_immigrant_population_by_state.html

Hospital costs by state:
http://www.governing.com/gov-data/health/average-medical-hospital-costs-by-state-map.html

Putting the graphs side by side is revealing. It correlates quite well, allowing for small statistical variations.

http://www.boston.com/news/health/articles/2008/04/20/organ_transplants_for_immigrants_stir_debate_in_calif/

It is also more likely that illegal aliens have Hepatitis, due to lower quality food and water supplys.

Obamacare does not help with this issue.

NOTE: On a final note, I suspect that hospitals also overplay the ‘uninsured’ count to try to give themselves more money.