Early Enrollees Sicker Than Average

April 15, 2014

Americans who signed up for health insurance in the Affordable Care Act (ACA) marketplaces early in the enrollment period were sicker than average, says FOX Business.

The health status of the insurance pools is critical because it will directly impact the cost of insurance premiums. The rollout of the new law has been marked by concern that only the elderly and the sick will sign up for health care through the exchanges -- causing a "death spiral" in the insurance industry. Without the young and healthy also enrolled, premiums would have to skyrocket to offset the costs of the sick. Already, insurers and policy experts are predicting double-digit premium hikes in 2015.

  • Pharmacy benefit management service Express Scripts has reported that exchange enrollees used specialty medications at higher rates than patients in commercial health plans. According to the report, six of the top 10 costliest medications used by ACA enrollees were specialty drugs, compared to only four of the 10 most expensive medications used by patients in commercial plans.
  • The amount of pain medication in exchange plans was also higher -- 35 percent higher than commercial plans. Antidepressant prescription proportions were also 14 percent higher in exchange plans, but the proportion of contraceptives was 31 percent lower.
  • More than six for every 1,000 prescriptions in the exchange plans were for HIV medications. This is four times higher than commercial health plans, according to Express Scripts.

So far, the White House has reported that more than 7 million Americans have signed up for federal or state exchange plans, but no information has been released on health status and age. Julie Huppert, vice president of Express Scripts, said that her company's survey confirms the concern that it was the sick and elderly who first signed up to get health care coverage.

As for the second half of the enrollment period, it is unclear whether younger and healthier enrollees sought out insurance. In mid-March, the Department of Health and Human Services announced that of 4.2 million enrollees, 25 percent were between the ages of 18 and 34.

Source: Kate Rogers, "Report: Early ACA Enrollees Were Sicker Than Average," FOX Business, April 8, 2014.

 

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