At the current moment, the Affordable Care Act (ACA) faces many legislative challenges and threatens healthcare coverage affordability, enrolment levels, and the overall stability of the non-group insurance market. This market serves a highly diverse population comprised of self-employed and unemployed individuals, early retirees, and those workers who do not have access to employer-sponsored insurance. It is clear that this population includes both healthy people and people with serious chronic diseases.
As Blumberg and Holahan (2017) state, the main problem with the ACA is that before its enactment, insurance was more affordable for healthy individuals, but a lot of people with health problems were often denied coverage by insurers or received limited benefits. Considering this, it is essential to analyze how the inclusion of high-risk population in the insurance program affects the level of enrolment and coverage costs in the non-group market.
Table G.1: Distribution of Non-Group coverage, Includes High-Risk Pool, by Age.
As the results of percentage change calculations presented in Table G.1 demonstrate, the age group of people aged 35-44 has the highest increase in the number of covered lives – 142,4%. According to Kennedy, Wood, and Frieden (2017), this age group of working adults with chronic conditions and disabilities was exposed to the largest number of disparities before the ACA. Thus, the increase in the enrolment level can be defined by a decrease in those disparities as a larger portion of the at-risk population in this age group obtained better access to coverage.
Nevertheless, considering that the percentage change in the same age group excluding the at-risk poll (Table G.2) is equated to 164%, it is possible to say that a significant number of healthy individuals aged 35-44 will likely find the coverage under new ACA conditions unattractive as they will have to pay more for the same amount of benefits and services.
When it comes to costs, the largest increase is observed in the group aged 55 and more (68,1%). Such a rise can be associated with general greater healthcare expenditures in older populations defined by the need to manage comorbidities, impairments, and the overall death proximity (Hazra, Rudisill, & Gulliford, 2017). However, when comparing this cost increase with the results of the same age group presented in Table G.2, it becomes clear that the inclusion of high-risk population makes the percentage change less steep, meaning that older individuals with chronic conditions can bear fewer coverage expenditures under the ACA.
Table G.2: Distribution of Non-Group Coverage, Excluding High-Risk Pool, by Age.
To sum up the analysis findings, it is appropriate to note that the ACA helps deal with disparities to which vulnerable populations were exposed in the non-group coverage market. At the same time, when people with chronic conditions are provided with greater access to coverage, insurers find it difficult to manage all expenses and, as a result, healthy individuals may suffer due to increased costs. Such a situation can have an unfavorable effect on the overall insurance program enrolment level. Policymakers should make some changes in legislation to stabilize the market and eliminate existing threats.
References
Blumberg, L. J., & Holahan, J. (2017). Stabilizing and strengthening ACA nongroup markets. Web.
Hazra, N. C., Rudisill, C., & Gulliford, M. C. (2017). Determinants of health care costs in the senior elderly: Age, comorbidity, impairment, or proximity to death? The European Journal of Health Economics, 19(6), 831-842.
Kennedy, J., Wood, E. G., & Frieden, L. (2017). Disparities in insurance coverage, health services use, and access following implementation of the affordable care act: a comparison of disabled and nondisabled working-age adults. Inquiry: A Journal of Medical Care Organization, Provision and Financing, 54, 46958017734031.