WSJ: Sicker Drawn to New Healthcare Coverage

Wednesday, 25 Jun 2014 08:58 AM

By Drew MacKenzie

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Obamacare patients enrolled in new plans have more serious health disorders compared to other healthcare plans, which could result in higher premiums next year, according to a review of medical claims, The Wall Street Journal reported.

More than one in four people, 27 percent, enrolled in the federal and state healthcare exchanges who saw medical practitioners in the first quarter of the year had health problems such as diabetes, asthma, heart issues, psychiatric conditions, or cancer, the analysis showed.

The figure is sharply steeper than the rate of 16 percent of people with similar health concerns who had individual coverage for the same period before Obamacare launched, according to the data from Inovalon, a technology firm handling medical claims from almost 200 healthcare insurance companies.

The number is also more than double the rate of people, 12 percent, who held onto their existing policies after the Affordable Care Act launched in January. The findings show that these so-called grandfathered patients have the lowest rates for healthcare services such as emergency-room visits, hospital stays, and prescriptions, according to the Journal.

The analysis of health conditions is "a good leading indicator of where medical costs are going," said Dan Rizzo, Inovalon's chief innovation officer, told the Journal. He said the data from 16 states had given a "representative mix of the experience of health plans" nationally.

The Obama administration plans to let people with grandfathered plans keep their existing coverage at least into 2016, which could result in a rate rise for premiums, the Journal reported.

The data indicates two entirely different healthcare markets under Obamacare, with less healthy people costing more in new plans while healthier consumers have kept their existing coverage, according to the Journal.

Cliff Gold, chief operating officer of CoOportunity Health, a health-insurance startup serving Iowa and Nebraska, said the figures show there is "a parallel market where the healthier people stay in the transitional plans." He noted that CoOportunity Health is planning to raise rates by an average of 14.3 percent for health plans in Iowa.

The findings do not include people who signed up in the final weeks of the enrollment period, which went into April in some cases. Younger and healthier enrollees, in general, joined Obamacare in the latter stages of the sign-up time frame.

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