Newly insured individuals under the Affordable Care Act have higher rates of disease and received significantly more medical care, on average, than those who enrolled in coverage prior to 2014, when major provisions of the health law took effect, the Blue Cross and Blue Shield Association said in a new study of its policyholders.
For the study, BCBS looked at medical claims among those enrolled in individual coverage before and after the ACA took effect. The study also compares this group to those who receive insurance through their employers.
Here are three findings from the study.
1. The study found people newly enrolled in BCBS individual health plans in 2014 and 2015 have higher rates of certain diseases such as hypertension, diabetes, depression, coronary artery disease, human immunodeficiency virus and hepatitis C compared to individuals who already had BCBS individual coverage.
2. BCBS said consumers who newly enrolled in BCBS individual health plans in 2014 and 2015 received significantly more medical services in their first year of coverage, on average, than those with BCBS individual plans prior to 2014 who maintained BCBS individual health coverage into 2015, as well as people with BCBS employer-based group health coverage.
3. Additionally, consumers who newly enrolled in BCBS individual health plans in 2014 and 2015 used more medical services across all sites of care — including inpatient hospital admissions, outpatient visits, medical professional services, prescriptions filled and emergency room visits.
4. Medical costs associated with caring for the new individual market enrollees were, on average, 19 percent higher than employer-based group members in 2014 and 22 percent higher in 2015, the study found. For example, the average monthly medical spending was $559 for individual enrollees compared to $457 for employer-based group members in 2015.
"The data underscores the need for health insurers, medical professionals and newly insured consumers to work together to ensure that individuals understand their benefits, and use them to improve their health and well-being," BCBS said in its study. "BCBS companies are changing their individual health plan products to enhance care management programs to address the unique needs of this population."
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