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Blue Cross finds ACA enrollees to be sicker

🕐 2 min read

WASHINGTON – Consumers who signed up for Blue Cross Blue Shield health plans through the Affordable Care Act’s insurance marketplaces these last two years tended to be sicker and incurred greater medical costs than people with BCBS coverage through their jobs.

The enrollees in those individual health plans in 2014 and 2015 had higher rates of diabetes, depression and heart disease, according to a report released Wednesday by the Blue Cross Blue Shield Association.

Medical costs for individuals who obtained coverage through the ACA’s insurance exchanges were, on average, 22 percent higher than for those with employer-based coverage in 2015, according to the association. Average monthly medical spending per member was $559 for individual enrollees in 2015, for example, versus $457 for group members.

The association represents 36 plans that together provide health-care coverage for nearly 105 million members – about one in three Americans.

The report provides some of the best data so far on the health status of people buying individual insurance since the 2010 health-care law took effect, especially because the plans examined are major players in the ACA marketplaces in 46 states and the Districtof Columbia, said Larry Levitt, a senior vice president with the Kaiser Family Foundation.

Levitt said the data is likely to help insurers determine what kinds of premium-rate increases they might seek from state regulators for 2017. The deadline for submitting rate increases is early May.

Under the law, no one can be denied coverage because of a pre-existing medical condition. Researchers and policy experts have always predicted that new enrollees during the first few years would include many older, sicker consumers who previously lacked insurance. But over time, companies and others hope the cost of caring for those enrollees will be balanced out by enrolling younger, and presumably healthier, individuals.

A spokesman for the Department of Health and Human Services said it was no surprise that people with newly obtained access to coverage needed more health care.

“After years of being discriminated against, Americans with pre-existing conditions are no longer locked out of coverage because of a health condition like asthma or diabetes,” Ben Wakana said in a statement.

Average monthly medical spending per member for new participants in BCBS individual plans rose from $501 during the first nine months of 2014 to $559 in the first nine months of 2015, the analysis found. All types of medical services had increases, including hospital admissions, prescriptions and emergency room visits.

By comparison, spending on people with employer-based coverage went up 8 percent, from $422 to $457, during the same periods.

The analysis examined the medical claims of 4.7 million individual members and 25 million employer-based group members enrolled in BCBS plans as a representative sample.

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