With the expansion of the Affordable Care Act (ACA), new enrollees are sicker and had incurred higher medical costs than those who already had healthcare policies, a new report says.
The report shows the actual medical claims among people who enrolled before and after the ACA was implemented.
Released by the Blue Cross and Blue Shield Association (BCBS), the study found that among those who enrolled under the ACA or otherwise known as the Obamacare in 2015, many were already too sick to be insured. As a result, Health insurers gained a sicker and more expensive patient population after the coverage expansion enacted under the ACA.
Highlights Of The Study
The study showed [PDF] that those who enrolled in the latter health plan had higher rates of chronic diseases like diabetes, depression, hypertension, coronary artery disease, Hepatitis C and Human Immunodeficiency Virus (HIV) infection than those who acquired of a BCBS individual coverage before the reform was implemented.
In terms of medical care, clients who acquired health plans between 2014 and 2015 acquired more medical services than those who enrolled with BCBS plans before 2014.
The medical costs also rocketed in the past two years. Medical costs of care for new individual members were 19 percent higher than employer-based group members in 2014. In 2015, it increased to 22 percent. New members acquired services such as inpatient and outpatient admissions, medical professional services, emergency room visits and prescriptions.
In summary, those who newly enrolled to individual health plans in the period from 2014 to 2015 had higher rates of diseases requiring more medical services and costs.
Focus More On Prevention And Wellness
At present, however, BCBS companies are expanding and improving their patient-focused care programs. These programs aim to emphasize more on wellness, prevention and coordinated care so new enrollees can recover faster and stay healthy longer. As a result, medical costs will also decrease over time.
BCBS senior vice president Alissa Fox said that the findings of the study show a need for better care management. These programs will help reduce emergency room visits and even hospitalizations. Focusing more on improved prevention of chronic diseases will help patients take control of their health.
This means that preventive measures like cholesterol control, blood glucose control and vaccinations will be implemented to help patients maintain a healthier status and reducing medical costs incurred from chronic diseases.
Photo: Yuya Tamai | Flickr