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Blue Cross Blue Shield Study: Obamacare Enrollees Use More Medical Care and Are Sicker

April 6, 2016 // News

blue-cross-blue-shieldAccording to a report released last week by Blue Cross Blue Shield Association, Obamacare enrollees in 2014 and 2015 used more medical services and are sicker than their counterparts who obtained coverage prior to the mandate. Though expected, the lower enrollment of younger, healthier, adults still plague the industry.

The Findings:

  1. Members who newly enrolled in BCBS individual health plans in 2014 and 2015 have higher rates of certain diseases such as hypertension, diabetes, depression, coronary artery disease, human immunodeficiency virus (HIV) and Hepatitis C than individuals who had BCBS individual coverage prior to health care reform.
  1. Consumers who newly enrolled in BCBS individual health plans in 2014 and 2015 received significantly more medical care, on average, than those with BCBS individual plans prior to 2014 who maintained BCBS individual health coverage into 2015, as well as those with BCBS employer-based group health insurance.
  1. The new enrollees used more medical services across all sites of care—including inpatient admissions, outpatient visits, medical professional services, prescriptions filled and emergency room visits.
  1. Medical costs of care for the new individual market members were, on average, 19 percent higher than employer-based group members in 2014 and 22 percent higher in 2015. For example, the average monthly medical spending per member was $559 for individual enrollees versus $457 for group members in 2015.

The study included both state-based and federally-facilitated marketplace enrollees between the ages of 21 and 64 (Medicare and Medicaid over age 65 excluded). It also included those who obtained individual plans that were ACA compliant.

According to Blue Cross Blue Shield, their BCBS companies across the country have the broadest participation in the marketplace than any other insurance company.




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