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”