HIX enrollees’ health issues as costly as anticipated

In what’s being described as the first comprehensive research examining the health status of HIX enrollees, the Kaiser Family Foundation has confirmed industry suspicions that public exchanges would cover a sicker population than traditional avenues.

A telephone survey of 742 U.S. adults also reveals some differences in the self-reported health status of participants in plans that comply with the Affordable Care Act and non-compliant plans that may influence future insurance rates.  

KFF found that 16% of respondents who purchased plans on state exchanges rated their health as “fair” compared with 11% of the overall sample, while about 4% of HIX enrollees said their health was “poor,” compared with 2% in individual plans sold off the exchanges and less than 0.5% of those in non-compliant plans that will be phased out in the next three years. In addition, 21% of HIX plan participants described their health as “excellent” versus 24% of all survey respondents.

“This is a market very much in flux, and we will track experiences and perceptions over time as new people enroll and those already in the market gain more experience using their new plans,” says Liz Hamel, director of the KFF’s public opinion and survey research. “While the share of the overall population enrolled in the non-group market is small, their views and experiences will have outsized significance in terms of whether the ACA is viewed as a success or not.”

Also see: Choice a ‘major disruptor’ to health care system

Most of the respondents in ACA-compliant plans (82%) reported that they were in excellent, very good or good health – a conclusion that was even higher among non-compliant plan participants (93%). Those who enrolled in compliant plans were more likely to report being in “fair” or “poor” health than those in non-compliant plans (17% vs. 6%), which KFF researchers expected because the ACA “required insurers to accept all enrollees, regardless of their health.”

The survey, which was conducted in April and May by SSRS on behalf of KFF, also found that 57% of HIX enrollees were uninsured just prior to obtaining coverage, with most saying they had been without coverage for at least two years. 

“There has been considerable debate about how many people signing up for coverage in the new exchanges were uninsured,” noted KFF President and CEO Drew Altman, adding that the survey found that most HIX enrollees “were previously uninsured.”  

Bruce Shutan is a Los Angeles freelance writer.