When the Patient Protection and Affordable Care Act went into effect a few years ago, one of its provisions ensured that Americans with pre-existing conditions would have to be covered by health insurers regardless. Now, data suggests that as these people got the chance to find coverage, new individuals in the health insurance ecosystem overall tended to be sicker, driven by people who had previously been denied individual plans.
In fact, the people who have signed up for coverage in the 2014 and 2015 open enrollment periods generally tended to have higher risk of certain diseases including diabetes, depression, heart disease, HIV, and Hepatitis C than those who were on individual plans prior to those years, according to an analysis of internal data from the major health insurer Blue Cross Blue Shield. In addition, those people tended to seek a lot more treatment than the average enrollee in the first year that they obtained the policies. Likely, they had gone a long time without addressing their serious health concerns as a result of the potential cost.
Indeed, those recent enrollees tended to use their newfound coverage to tap all kinds of medical services, the report said. That includes checking into the hospital, getting outpatient treatment, visiting the emergency room, visiting independent doctors, and obtaining prescription drugs.
A closer look at the numbers
For instance, enrollment among consumers with HIV increased the most during this period, rising 242 percent in comparison with enrollment numbers prior to 2014, the report said. Hepatitis C also saw enrollment increase 140 percent. Next came diabetes, with a 94 percent increase, and depression at 52 percent. Coronary artery disease (up 32 percent) and hypertension (24 percent) rounded out the list.
What's the impact?
The data suggests that these people were racking up medical costs that were about 19 percent higher than those from Americans enrolled in insurance through their employers in 2014, the report said. That gap rose to 22 percent the next year. The average person who was relatively new to health insurance coverage was therefore spending about $559 per month on health care last year, compared with $457 for those who had employer-based policies.
The largest portion of that money ($163) was spent on outpatient care, with professional medical services not far behind at $154, the report said. Finally, prescription costs and inpatient treatment both came in at $121.
These numbers highlight some very clear issues that the health insurance industry, and care providers themselves, will have to deal with. One of the big problems that many consumers encounter once they finally get coverage after potentially years of going without is that they may not fully understand their policies, and what those plans do and do not cover. Education efforts can therefore be massively important to helping all involved get on the same page and potentially bring down these costs without impacting the quality of care.