When health insurance isn’t enough (WaPost)

September 5, 2011

When health insurance isn't enough By Kliff

We have a lot of numbers to estimate how many people will gain health insurance

under the Affordable Care Act. The Congressional Budget Office estimates it will

hover around 34 million, with 24 million purchasing coverage through the new

health exchange marketplaces. We think, based on a study published this week and

the Massachusetts experience, that the majority of the uninsured plan to comply

with health reform's mandated purchase of health insurance.

But there's one crucial detail we don't have much information on at all: what

those 34 million people will do with their health insurance once they get it.

And it's actually a pretty open question in the health policy research, whether

the newly-insured use more health services (making up for the earlier lack of

coverage) or continue to act as they did prior to gaining coverage.

The latest research says it looks more like the latter: the newly-insured tend

to act more like the uninsured, according to a study published earlier this week

in the journal Health Economics (hat tip: the Incidental Economist). The study

looked at Medicare enrollees, comparing newly-qualified seniors who had health

insurance before turning 65, versus those who did not. It finds that those who

did not have insurance had 11 percent fewer doctors visits than those who had

insurance prior to gaining Medicare coverage.

Interestingly though, this study didn't find a cost difference between these two

populations. Even though the previously-uninsured got less medical care, they

gravitated to more expensive treatments, with 18 percent more visits to the

emergency room and 43 percent more hospital outpatient trips.

These numbers are bad news for our attempt to control health cost growth. The

health reform law's insurance expansion is largely meant to encourage greater

preventive care, to curtail the more expensive hospital and emergency room

treatments. If it doesn't - and our patterns of care look pretty similar to what

we have now - we're in some trouble.

What this means for implementation, I think, is that any public outreach

campaigns on the health insurance expansion will have to do more than get

Americans enrolled. It will have to do a pretty good job explaining what it

means to have health insurance, and how to use it. Or, as the study authors put

it, " both health insurance coverage and other policies that facilitate access to

physician services among the previously uninsured may be necessary to

substantially alter their use of health care. "

By Kliff | 02:30 PM ET, 09/04/2011

nough/2011/09/04/gIQApuBu1J_blog.html

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