Reform success depends on more than enrollment


Affordable Care Act enrollment surpassed expectations, with roughly 20 million people gaining insurance under the law as of May 1. But measures other than enrollment are more important to gauge how well the law works, The Wall Street Journal reported.

Several factors, including the overall health status of enrollees, the number of young adult sign-ups and the male-to-female ratio will determine success. But it could take more than a year to evaluate how well the U.S. healthcare system performed on these measures, the article noted.

Insurers are still finding out the health status of their new enrollees; however, a recent analysis of medical claims suggest insurance exchange enrollees are sicker and costlier than people sticking with previous coverage, FierceHealthPayer previously reported. Health technology firm Inovalon Inc. found people enrolled in new healthcare reform plans have higher rates of serious health conditions than other insurance customers.

How many young people signed up for coverage also plays a big role in determining reform success. The Kaiser Family Foundation said 40 percent of enrollees need to be 18 to 34 years old. But federal officials said young adults comprised only 24 percent of the 2 million exchange enrollees as of January.

Looking at the gender mix of exchange enrollees, 54 percent are female and 46 percent are male, the WSJ noted. Insurers should take note of the almost 10-point gender gap, considering females between the ages of 18 and 64 can have 20 percent higher healthcare costs than the average costs for men.

Insurers are still paying claims and checking eligibility of reform customers, so industry analysts still don't have enough credible data to measure reform success or failure. "I don't have one client that actually has a really good feeling for what their receivables are yet," Bill Copeland, a healthcare expert with Deloitte, told the WSJ.

For more:
- read the WSJ article

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