Truven Health Analytics, formerly the Healthcare business of Thomson Reuters, released a study today that projects the impact to states, health plans and healthcare providers of insurance coverage expansion under the Affordable Care Act (ACA).
The study, Coverage Expansion Under the ACA: Challenges for Government, Health Plans, and Providers, draws its conclusions from the Truven Health Insurance Coverage Estimates database, which contains current Medicare, Medicaid and private insurance enrollment rates, along with geographic, population, demographic, and other data. This information was analyzed to estimate bottom-line impacts when the ACA takes effect in 2014. Projections are reported on a state-by-state and national basis for scenarios in which the state opts-in to the ACA and those in which the state opts-out of the program.
“The U.S. Supreme Court’s decision last June to uphold the individual mandate of the ACA, but prohibit penalties for states that elect not to expand Medicaid, created uncertainty about the volume and health risk profiles of newly insured patients that can be expected starting in 2014,” said Mike Boswood, Truven Health Analytics president and CEO. “However, by 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.”
Following were among the key findings of this study:
- Medicaid, Exchanges Face Major Additions: Medicaid enrollment will increase from 47 million in 2012 to 53 million in 2016. The number of patients enrolled in Affordable Insurance Exchanges will be 21 million in 2016, assuming partial national opt-in to the ACA.
- Twenty Two Million Uninsured to Get Coverage: The number of uninsured Americans will drop from 49 million in 2012 to 27 million in 2016, assuming partial national opt-in to the ACA.
- Los Angeles and New York to See Largest Absolute Increases in Medicaid Rolls: Los Angeles and New York metro areas will have the largest absolute increase in Medicaid enrollment; the largest percentage growth will occur in Austin, San Antonio and Houston, TX, if their states opt-in to the ACA.
- Newly Insured Have Lower Reported Use of Services: Based on analysis of insurance claims data, the study found that the cohort of Americans who would be newly insured under the ACA use health services at much lower rates than currently-enrolled adults. This is likely to change once they are insured.
“In addition to the significant state-level variability in approaches to the ACA, our analysis of population profiles for the newly eligible reveals a number of factors that can impact the cost of care positively or negatively,” said Gary Pickens, chief research officer at Truven Health Analytics. “By modeling those cost impacts under a range of different scenarios across all demographic and geographic groups, we are able to get a much clearer picture of what’s in store for healthcare stakeholders in the coming years.”Read the full report here.