Dive Brief:
- The Blue Cross Blue Shield Association (BCBSA) has released a new report illustrating that individuals who enrolled in BCBS health plans following the implementation of the Affordable Care Act have overall been sicker and more costly than individuals who enrolled in BCBS plans before 2014.
- The report compares the actual medical claims of those enrolled in individual coverage before and after the ACA, and also compares those in BCBS individual plans to those in BCBS employer-based plans.
- BCBSA notes BCBS insurers have participated in the ACA marketplaces more broadly across the U.S. than any other carrier, providing the largest single group of individuals that can be studied for insights into their health and costs.
Dive Insight:
The report comes amid insurers' efforts to sway federal policies to make participation in the ACA marketplaces more favorable for insurers, as Forbes notes, and while it is widely accepted that early ACA plan enrollees have tended to be sicker and have pent-up medical needs, the BCBSA report puts a number on the increased cost of care.
It finds these members were, on average, 19% costlier than employer-based group members in 2014 and 22% costlier in 2015. The average monthly medical cost in 2015 for individual plan members was $559 vs. $457 for group members.
Among the study's key findings are individual enrollees in 2014 and 2015 have higher rates of diseases including hypertension, diabetes, depression, coronary artery disease, HIV and Hepatitis C; that these enrollees received "significantly more" medical care; and that they utilized more services across all sites of care.