New data reinforces the picture of insurance exchange enrollees as sicker and costlier than people sticking with previous coverage. Health technology firm Inovalon Inc. analyzed medical claims and found people enrolled in new healthcare reform plans have higher rates of serious health conditions than other insurance customers, The Wall Street Journal reported.
About 27 percent of exchange enrollees who have seen a doctor or provider in the first quarter of 2014 have significant health issues, including diabetes, psychiatric conditions, asthma, heart problems or cancer. That's more than double the 12 percent of people who kept grandfathered individual plans.
New enrollees who purchased coverage through the marketplaces also are more likely to use specialty medications, such as those used to treat HIV/AIDs and hepatitis C, than people enrolled in commercial health plans, according to April research from Express Scripts. In exchange plans, specialty meds accounted for about 1.1 percent of total prescriptions, compared to 0.75 percent in commercial plans. Sovaldi--the costly drug to treat hepatitis C, came in second for total spending, FierceHealthPayer previously reported.
In addition to medical claims, a recent survey from the Kaiser Family Foundation suggests people who purchased ACA coverage have worse health than those who bought individual plans outside of the exchanges or still hold plans that don't comply with the reform law.
"It's even worse than what we thought," Patrick Getzen, chief actuary for Blue Cross & Blue Shield of North Carolina, said of the health status of new enrollees. "We're seeing more chronic conditions than we would have expected," he told the WSJ, and that will "put pressure on the 2015 rates."
However, Inovalon's claims data didn't include last-minute sign ups during the final weeks of open enrollment. That was when many insurers said they received younger, and potentially healthier, enrollees, the WSJ noted.
- read the WSJ article