Administrative claims data from 2012 are used from Texas and Washington State to understand state differences in the likelihood of non-urgent emergency department utilization prior to the implementation of the Affordable Care Act. Texas is currently the largest state that has opted to not expand Medicaid. Washington State has expanded Medicaid, and it had more generous pre-expansion Medicaid income eligibility criterion compared to Texas. I find that emergency department use for non-urgent reasons was higher in Texas compared to the state of Washington in 2012. Additionally, in Texas, there was a disproportionately high demand for obstetric services that are typically provided in outpatient settings. Non-urgent emergency department demand was associated with disruption in Medicaid coverage in both states. In Texas, especially, Medicaid coverage disruption and rural area residency were associated with higher likelihood of emergency department use for emergent but primary care treatable reasons.
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