Sicker, costlier patients on ACA plans should come as no surprise

Statistics released this week by the Blue Cross Blue Shield Association (BCBSA) indicating that new Affordable Care Act enrollees were sicker and costlier should surprise no one, least of all the insurance companies that provided those plans, according to analysis by the New York Times' The Upshot.

The report, released earlier this week, showed that BCBS plans saw higher rates of members with chronic illnesses such as hypertension, diabetes, coronary artery disease, HIV and hepatitis C, and therefore used more services once ACA mandates allowed high-risk individuals to obtain coverage in 2014.

Unsurprisingly, an influx of sicker patients who previously were unable to obtain healthcare coverage translated to higher costs. But the report only paints half the picture, according to The Upshot. Although health insurers are required to mix high-risk and low-risk customers in one pool in order to offset costs, BCBSA singled out newer, sicker patients, insinuating that ACA marketplaces were to blame. A more accurate measurement would be the overall costs of insuring both groups.

Last year, medical costs outpaced premiums in BCBS plans, and major insurer UnitedHealth has threatened to pull out of ACA exchanges amid $720 million in losses. Other insurers have echoed concerns that ACA plans are unsustainable, and moved to discourage consumers from signing up for coverage during special enrollment periods, citing abuse.

On the other hand, many have argued that insurers are to blame for ACA losses for failing to accurately calculate rates. 

For more:
- read The Upshot analysis

Suggested Articles

The Trump administration has announced it would reject Utah's plan to cap expanded Medicaid enrollment while still earning full federal funds.

Canadian officials got an earful from the healthcare industry over the U.S. proposal to import drugs from the country.

CMS approved a waiver for Colorado to set up a reinsurance program for its ACA exchange.