Are Obamacare enrollees less healthy?

blue cross blue shieldThe Blue Cross and Blue Shield Association (BCBSA) recently released the results of a study which examined the healthcare utilization of members who enrolled in their health plans since the roll-out of the Affordable Care Act — known as Obamacare by many.  Not surprisingly, the report found that members who enrolled in Obamacare plans were on average less healthy than their counterparts who enrolled in Blue Cross Blue Shield individual health insurance plans prior to the launch of health insurance marketplace plans in 2014.

Among other key findings, the study found that:

Consumers who newly enrolled in Blue Cross Blue Shield (BCBS) individual health plans in 2014 and 2015 received significantly more medical care, on average, than those with BCBS individual plans prior to 2014 who maintained BCBS individual health coverage into 2015, with the same being true when compared to those enrolled in employer sponsored coverage via BCBS.

At a high level, the study found that a handful of selected conditions occurred much more frequently among enrollees in the new Obamacare environment. Specifically, HIV occurred 242% more often, Hepititis C (140%), Diabetes (94%) among others.conditiondiff

This finding should not be a surprise as one of the key components of the Affordable Care Act (ACA) was that individuals could not be declined due to pre-existing medical conditions, nor could these individuals be required to pay higher monthly premiums as a result of these pre-existing conditions.   This ACA component alone would clearly lead to a less healthy membership base, as prior to the implementation of Obamacare the sickest segments of the population could be denied enrollment.

The individual mandate, requiring all Americans to enroll in a qualified health plan — including the young and healthy segment of the population who many times did not purchase health insurance — was intended to balance out the selection issues caused by the guaranteed issue component.

This Obamacare health care study seems to indicate that the the two aforementioned components have not balanced each other out for BCBS plans to date specifically.  This analysis is relatively new and should be revisited in several years to truly determine the long term impacts of Obamacare on the claims experience for health insurance carriers.  One thing is clear, through the first few years since the launch of Obamacare, some national carriers have reported losing hundreds of millions of dollars in some cases resulting from these rule changes including many BCBS member health plans, and UnitedHealthcare among others.  Time will tell whether healthcare utilization balances out in the years to come, or whether sicker segments of the population seem to migrate to specific companies such as Blue Cross Blue Shield for example.


Other information you might be interested in: Blue Cross Blue Shield contact info.BCBSA study on Obamacare claims experiencelowest BCBS rates on exchange plans by state for 2016, video explanation of Obamacare

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