People who enrolled in a Blue Cross Blue Shield health plan after enactment of the Affordable Care Act (ACA) have higher rates of disease and received significantly more medical care compared with those enrolled before the ACA was enacted.
People who enrolled in a Blue Cross Blue Shield (BCBS) health plan after enactment of the Affordable Care Act (ACA) have higher rates of disease and received significantly more medical care, on average, than those who enrolled in BCBS individual plans before 2014, according to a new study by BCBS Association.
Nationwide, BCBS companies have participated in the new ACA marketplaces more broadly than any other insurance carrier, according to BCBSA; thus, the millions of new BCBS members provide the largest single group of individuals whose health status and use of medical services can be examined to see the medical needs and costs associated with providing care.
The report, “Newly Enrolled Members in the Individual Health Insurance Market After Health Care Reform: The Experience from 2014 through 2015,” provides an in-depth look at actual medical claims among those enrolled in individual coverage before the ACA went into effect. This group of enrollees was compared with those who receive insurance through their employers, and includes adults ages 21 through 64 who purchased coverage through state-based and federally facilitated marketplaces, as well as individual, ACA-compliant policies sold outside the marketplaces (no Medicare or Medicaid recipients were included).
The major findings of the study include:
The findings underscore the need for healthcare providers, insurers, and newly insured people to work together to make sure that consumers get the right health care services in the right setting at the right time, said Alissa Fox, BCBSA senior vice president of the office of policy and representation.
However, given that individuals gaining access to healthcare coverage under the Affordable Care Act may be gaining coverage for the first time, it’s unsurprising they need the most care, Ben Wakana, a spokesman for the Department of Health and Human Services, told The New York Times.
In addition, the article noted, new insurance policies are often more comprehensive than individual policies sold before the ACA went into effect; for example, new policies must cover maternity care and mental health and substance abuse services. Researchers and health policy experts had predicted that people with higher medical costs would enter the market in the first few years of the public insurance exchanges, and the ACA provided special payments to insurers with unexpectedly high costs.