Study: Early Enrollees in Health Exchanges Are Older, Sicker
U.S. residents who gained coverage in January and February through the Affordable Care Act's insurance exchanges were generally older and had more serious health conditions, compared with individuals who had coverage through their employers, according to a study released Wednesday by Express Scripts, the New York Times reports (Thomas, New York Times, 4/9).
According to Daily Beast/Kaiser Health News, Express Scripts officials say the findings offer an early glimpse at the characteristics of enrollees in the exchanges and their health care status and needs. Analysts say such data could influence how insurers set premiums for their plans in the exchanges next year. The proportion of sicker enrollees to healthy enrollees also will be essential, because insurers need a larger number of healthy enrollees to offset the cost of treating the older, sicker set.
For the study, researchers analyzed more than 650,000 claims that were filed in January and February with 25 insurers. They compared the data with claims information from a subset of employer-sponsored health plans that Express Scripts administers, according to the Daily Beast/KHN.
The study found that consumers with exchange plans used a:
- 35% higher volume of pain medication than consumers with employer-sponsored coverage;
- 31% lower volume of birth control prescriptions;
- 27% higher volume of drugs to manage seizures; and
- 14% higher volume of drugs to treat depression (Appleby, Daily Beast/Kaiser Health News, 4/9).
In addition, the survey found that six of the 10 most-costly drugs in the exchange plans were specialty drugs, compared with four of the most-costly drugs in employer-sponsored plans (New York Times, 4/9).
The survey also found that more than six out of every 1,000 prescriptions filed by an exchange enrollee was for an HIV drug, which is four times that of employer-based plans (Daily Beast/Kaiser Health News, 4/9).
According to researchers, the early exchange plan beneficiaries also were filling prescriptions at about the same rate as individuals with work-based coverage. However, the study found that consumers in exchange plans paid a larger percentage of their drug costs in the first two months than those with work-based insurance.
Health insurers paid 35% more per enrollee in an employer-based plan for prescription drugs than they did for exchange plan beneficiaries, according to the study. Julie Huppert, vice president of health care reform at Express Scripts, said that spending could become more even with time and as exchange plan enrollees reach their deductibles or maximum out-of-pocket spending (New York Times, 4/9).
Huppert said the study offers only "a snapshot of the population early on," adding, "The hope is the young and healthy come into the system in the later weeks of the enrollment period" (Daily Beast/Kaiser Health News, 4/9).
However, she noted that insurers setting their prices for next year might not have "enough time to assess much more than this" (New York Times, 4/9).This is part of the California Healthline Daily Edition, a summary of health policy coverage from major news organizations. Sign up for an email subscription.