People enrolled in new plans under the health law are showing higher rates of serious health conditions than other insurance customers, according to an early analysis of medical claims, putting pressure on insurers around the country as they prepare to propose rates for next year.
Among those health-law marketplace enrollees who have seen a doctor or other health-care provider in the first quarter of this year, around 27% have significant health issues such as diabetes, psychiatric conditions, asthma, heart problems or cancer, the data show. That is sharply higher than the rate of 16% for last year's individual-consumer market over the same time frame, according to the data, which was supplied by Inovalon Inc., a health-technology firm that receives medical claims directly from nearly 200 insurers that are its clients.
It is also more than double the rate among people who held on to their existing individual policies; among those enrollees, the rate was 12%. Those consumers, who kept so-called grandfathered individual plans, are showing by far the lowest rates of use for health-care services such as emergency-room visits, hospital stays and prescriptions.
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The findings provide the clearest picture so far of the health status of those who bought plans under the Affordable Care Act, and show a sharply bifurcated consumer insurance market—with sicker, and costlier, people in health-law plans and healthier people sticking with previous coverage.
Insurers say that dynamic could drive up premiums for many health-law plans next year, because the Obama administration recently announced that it would allow the grandfathered coverage to linger into 2016, if states and insurers choose.Read the rest of the story HERE and watch a related video below:
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