We do not know whether increases in coverage will lead to decreases in waste, because there is little direct evidence and because the theoretical relationships may have offsetting effects:

• No studies directly examine the effect of increasing coverage on waste.
• Clinical waste could decrease if the newly insured shift their patterns of utilization from less efficient to more efficient providers, particularly if they shift from using emergency departments for primary care to visiting physicians' offices.
• Administrative waste could increase if a significantly greater number of eligible persons are subjected to complex requirements needed to qualify for subsidies or to avoid penalties, and it could decrease to reflect reductions in uncompensated care.
• Operational waste is unlikely to be affected, because the policy change does not have a direct effect on the way the delivery system is organized.