Study Projects Impact of ACA
By Lisa Kerner, contributing writer
Truven study shows 6 million more people will be added to Medicaid and 21 million to affordable insurance exchanges starting in January, 2014
A recent study by Truven Health Analytics sheds light on what states can expect when the next stage of the Affordable Care Act (ACA) takes effect in 2014. Announcing the release of the report, Mike Boswood, Truven Health president and CEO, said, “Leveraging the power of big data and statistical modeling techniques, we are able to make detailed projections that bring much needed clarity to states, health plans, and providers on the changing dynamics of the soon-to-be-insured population so that they may plan accordingly.”
The study, Coverage Expansion Under the ACA: Challenges for Government, Health Plans, and Providers, offers scenarios on a state-by-state and national basis for opting in and opting out of the ACA program. It also reveals that, in preparing for implementation of affordable insurance exchanges (AIEs), 19 states plus Washington, D.C., have created state-based exchanges, 7 states are pursuing a state-federal partnership exchange, and 25 states have defaulted to a federally administered exchange.
The report projects Medicaid enrollment to jump by about 6 million to a total of 53 million participants by 2016, with Los Angeles and New York City seeing the largest absolute increases. In addition, about 21 million people are expected to be enrolled in AIEs by 2016, assuming partial national opt-in.
The Truven study indicates planning for the newly insured may be tricky with the “main unknown factor” being how the behavior of those newly eligible will change once they gain coverage as research on this is scarce. However, what research there is has shown that subsidized coverage versus lack of insurance increased the use of outpatient care by 35%, prescription drugs by 15%, and hospital inpatient care by 30%.
The newly insured seem to a complex bunch, according to the Truven study findings, with at least half lacking any coverage for a “significant” period of time, mostly due to cost. The future Medicaid eligible group appeared to be somewhat healthier than current Medicaid enrollees, while future exchange likely adults appeared to be somewhat less healthy.
The report came on the heels of an announcement by the Centers for Medicare & Medicaid Services (CMS) revealing it is building a tool called the Data Services Hub that will “provide one connection to the common federal data sources (including but not limited to SSA, IRS, DHS) needed to verify consumer application information for income, citizenship, immigration status, access to minimum essential coverage,” and more. The technical design has been completed and CMS has begun testing the hub, which establishes a cross-agency security framework and protects individual privacy.
CMS is building the Data Services Hub as part of its attempt to “build the Health Insurance Marketplace, also known as the Affordable Insurance Exchange. Consumers and small businesses in every state (including the District of Columbia) will have access to the Marketplace.”