One of the frequent calls of caution from health care wonks and insurance industry folks who are actually trying to inform people instead of lobby for favorable treatment is to wait. We knew that there was going to be a massive amount of catch-up care as people who either were uncovered, sporadically covered or had no usable insurance because the cost sharing was atrocious got coverage through either Medicaid expansion or the Exchanges. The big question was always how much catch up care was happening and if/.when would it subside as crisis care converted into maitenance care.
There is starting to be some evidence that the catch up care wave is subsiding:
— Emily Yunker (@EmilyYunkerCWS) February 2, 2016
The blue line is the Ohio Medicaid expansion population’s rate of inpatient stays per 1,000 enrolled months. This group started at 30 stays per 1,000 enrolled months. My guess is that these were deferred surgeries and treatments for chronic conditions that had been put off. Furthermore, the first people to always sign up for a guaranteed issue insurance product are the people who know that they need it because they are very sick. However, the catch-up care line dropped significantly and now the expansion population has an inpatient hospitalization rate similar to that of the fairly healthy but low income Legacy Medicaid population.
The same phenonmamn has occurred on Exchange. The first people to sign up in November 2013 were sick as hell. It is only in the most recent open enrollment period where the populations are starting to get healthier and the catch up care is subsiding as most of the self-identified high risk folks have been in the system for a year or more.
This uncertainty about catch-up care was why there were the three R’s of risk adjustment, risk corridors and re-insurance. No one knew how many expensive surprises were out there.