One of the key factors that will determine the success of President Obama’s healthcare law is whether there are enough young and healthy enrollees to offset the costs of covering older and sicker participants, particularly those with pre-existing conditions.
An October report from Express Scripts, the nation’s largest manager of pharmacy benefits, has found that people who gain insurance coverage through the law’s exchanges are much more likely to use expensive drugs known as specialty drugs.
“Health exchange members are 59One of the key factors that will determine the success of President Obama’s healthcare law is whether there are enough young and healthy enrollees to offset the costs of covering older and sicker participants, particularly those with pre-existing conditions.
An October report from Express Scripts, the nation’s largest manager of pharmacy benefits, has found that people who gain insurance coverage through the law’s exchanges are much more likely to use expensive drugs known as specialty drugs.
“Health exchange members are 59% more likely to have filled a prescription for a specialty medication,” the report read. “HIV is the top specialty condition for health exchange members aged 18 to 64, particularly among those who live in a zip code with a low median income. Nearly 3 out of 5 specialty claims overall are for HIV medications. Additionally, compared to health exchange members without HIV, those who take HIV medications are also much more likely to be taking drugs for hepatitis C, hepatitis B, viral infections and smoking cessation.”
Specialty drugs made up 1.3 percent of claims but accounted for 38 percent of spending on prescription drugs on the exchanges, the report found.
The average age of enrollees on Obamacare exchange plans, at nearly 44, was seven years greater than those who gained coverage outside the exchange, and 30 percent of health exchange members were between the ages of 55 and 64, compared to 15 percent among people with outside health plans.
That said, the study also found that people who signed up for coverage later in the open enrollment period had a “lower prevalence of chronic conditions, such as heart disease, depression, high cholesterol and diabetes, and a lower prevalence of specialty conditions, such as cancer and multiple sclerosis.” This supports the observation, which has been backed up by other data, that those who signed up for coverage through Obamacare the earliest were older, while younger applicants waited to apply.
A lawsuit is seeking to stop congressional staffers from enrolling in D.C.’s exchange
The conservative legal group Judicial Watch has filed a taxpayer lawsuit against the District of Columbia’s Health Benefit Exchange Authority, challenging the participation of thousands of members of Congress, staffers, and their families in the small business exchange.
House and Senate workers were pushed into the exchange under a provision of Obamacare that sought to make sure Congress was subjected to the same health insurance that they were imposing on the rest of the nation. D.C. prohibits businesses with more than 50 employees from enrolling in the small business exchange. The lawsuit argues that because Congress employs up to 20,000 people, it should be illegal for staffers to enroll.
The suit was filed in D.C. Superior Court on behalf of Kirby Vining, a D.C. taxpayer.
