The law of unin­tend­ed consequences…always the most dan­ger­ous legal game. This time we are hap­py that the Afford­able Care Act has caused an increase in the num­ber of insured indi­vid­u­als, who have prompt­ly tak­en advan­tage of their new found cov­er­age, and caused a major increase in the use of emer­gency rooms. While this is a nation­wide trend (The Amer­i­can Col­lege of Emer­gency Physi­cians said near­ly half of those ER docs queried showed a rise in the num­ber of ER vis­its this year and 86% expect an increase over the next three years), there are also more detailed local results. In Orange Coun­ty the ER patient load has risen by an aver­age 4.4% since Jan­u­ary 2014, while it had been flat the pre­vi­ous 4 years. UC Irvine is up 10.9%, Kaiser Orange Coun­ty up 11% and Foun­tain Val­ley 7.6%. Many of these are Medi Cal, many are with pri­vate insur­ance, but it is all up, all over…One tem­po­riz­ing thought came from Marc Futer­nick, pres­i­dent elect of the Cal­i­for­nia Chap­ter of the Amer­i­can Col­lege of Emer­gency Physi­cians. “Some of this may be a tem­po­rary phe­nom­e­non and could change as peo­ple begin to use their cov­er­age better…but to the extent that the health plans and net­works are send­ing peo­ple to the ER it’s not going to change”