Filed Under:Health Insurance, Individual Health

Analysis shows how the ACA swamped the individual market

About 78 percent of the new 2014 individual enrollees may have been in poor health

Three Affordable Care Act were supposed to keep unexpected flows of risk from drowning the individual market. (Photo: Ekaterina Shvaygert/Thinkstock)
Three Affordable Care Act were supposed to keep unexpected flows of risk from drowning the individual market. (Photo: Ekaterina Shvaygert/Thinkstock)

The Affordable Care Act helped insurers increase individual major medical enrollment to 10.9 million in 2014, from 7.9 million in 2010.

But about 2.3 million of the 3 million additional enrollees covered in 2014 had either a major health problem, such as cancer, or a serious but less severe health problem, such as high blood pressure or depression.

Related: Republicans keep up attacks on new health laws

About 1.4 million of the additional 2014 enrollees had a severe health problem, such as cancer or heart disease, that would probably have kept them from getting ordinary major medical coverage in states that allowed medical underwriting in the individual market before Jan. 1, 2014.

Officials at a policy office at the U.S. Department of Health and Human Services gave those figures in a commentary designed to show how the ACA has helped people with pre-existing conditions.

HHS based the commentary on data from the 2014 Medical Expenditure Panel Survey, a government survey that collects coverage information and detailed health status information at the same time.

The ACA banned use of personal health information other than age, location and tobacco use in individual major medical underwriting starting in January 2014.

HHS officials estimate that about 51 percent of all Americans under age 65 have some kind of condition, such as mild asthma, that could have made getting through the major medical application process difficult in 2013, and that 23 percent have a serious health problem that probably would have made getting medically underwritten coverage impossible.

The survey results also support health insurers' observations that many of the people who gained health coverage in 2014 had serious health problems.

About 55 percent of 2014 individual major medical users had a health problem using the broad definition of a health problem, and 27 percent had a health problem using the narrow definition.

In 2010, just 46 percent of individual major medical users had a health problem using the broad definition, and 20 percent had a health problem using the narrow definition, according to the HHS officials' data. 

The ACA created three programs that were supposed to protect issuers of individual health coverage against unexpected swings in claim risk, but Republicans blocked one, the risk corridors program from working, and a second program, the risk-adjustment program worked in ways that surprised managers of some smaller, newer carriers. A third program, the ACA reinsurance program, paid insurers more than they originally expected to pay, but it was set to end Dec. 31, 2016. It's supposed to pay reinsurance benefits for 2016 this year, but it will not protect insurers against claim risk in 2017, unless Congress decides to renew the program.


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Nichole Morford

Nichole Morford
Managing Editor

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