NY Times: Study Finds Sicklier Enrollees in Earliest Stage of Health Law

The health of those who enrolled in new coverage is being closely watched because many observers have questioned whether the new marketplaces would attract a large share of sick people, which could lead to higher premiums and ultimately doom the new law.

The study, to be released Wednesday by the major pharmacy-benefits manager Express Scripts, suggests that early enrollees face more serious health problems and are older than those covered by their employers. The study also showed a higher use of specialty drugs, which are often used to treat diseases like cancer and rheumatoid arthritis; the use of such drugs could hint at more costly medical problems.

Over all, early users of marketplace plans appeared to be filling prescriptions for drugs at rates similar to people with coverage through their employers. Another pharmacy-benefit manager, Prime Therapeutics, said it was seeing slightly higher rates of prescription-drug use among its marketplace customers.

“I think this gets under the hood of not only who is enrolling, but what kind of health care challenges do they have,” said Karen M. Ignagni, president of America’s Health Insurance Plans, which represents insurers. “Pharmacy claims are often an indicator for medical claims, and it’s often the case that they provide a real insight into overall trends.”

Still, she and others cautioned that it was too early to properly evaluate the health of those who were signing up. The study by Express Scripts looked at a sample of 650,000 consumers who received coverage in January and February and did not capture information about those who signed up closer to the enrollment deadline. Insurers have said anecdotally that those who signed up later tended to be younger and were presumably healthier.

Julie Huppert, vice president for health care reform at Express Scripts, said she expected to see the picture change as the year progressed. But she said this early glimpse was crucial for insurers, which were already setting their rates for next year.

Continue reading here: http://www.nytimes.com/2014/04/09/business/study-looks-at-earliest-health-law-enrollees.html?partner=rss&emc=rss&_r=0

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