On July 4, 2010, the Boston Globe ran a story on the Massachusetts health care law that began:

The number of people visiting hospital emergency rooms has climbed in Massachusetts, despite the enactment of nearly universal health insurance that some hoped would reduce expensive emergency department use.

On Wednesday, a Wall Street Journal story stated:

Early evidence suggests that emergency rooms have become busier since the Affordable Care Act expanded insurance coverage this year, despite the law's goal of reducing unnecessary care in ERs.

It might be time to consider whether emergency use is increasing not "despite" of coverage expansions, but because of them.

The Journal story is based on online survey of emergency room doctors prepared for the American College of Emergency Physicians and conducted in early April. The headline finding was that 46 percent of respondents said that the volume of emergency patients in their departments had increased since Jan. 1, when Americans began receiving coverage through President Obama's health care law, compared with 23 percent who said it decreased. Another 27 percent said volume remained the same. Looking forward, 86 percent expect visits to increase over the next three years.

Several caveats apply – the news is based on an online survey rather than actual data and it’s hard to draw any definitive conclusions just a few months in to the earnest implementation of Obamacare. But the physicians group notes several ways in which the law is putting more pressure on ERs.

"Emergency visits will increase in large part because more people will have health insurance and therefore will be seeking medical care," Alex Rosenau, president of ACEP, said in a press release. "But America has severe primary care physician shortages, and many physicians do not accept Medicaid patients, because Medicaid pays so low. When people can't get appointments with physicians, they will seek care in emergency departments. In addition, the population is aging, and older people are more likely to have chronic medical conditions that require emergency care."

It's important to remember that when President Obama was pitching his health care overhaul, he argued that expanding coverage would reduce emergency room visits because individuals would be able to get treated sooner. He was actually trying to make this point during that infamous viral video from the 2008 campaign when he blanked on the term asthma "inhaler" and used "breathalyzer" instead. His intended point was that somebody whose asthma was treated earlier wouldn't wind up in the emergency room, and thus universal coverage was actually fiscally prudent.

Of course, if newly covered individuals are seeking care and they cannot find doctors who accept their coverage and have available appointments, they’ll end up in emergency rooms in greater numbers.