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Don't panic yet, but early Obamacare enrollees might cost more

Obamacare enrollees might be using the more expensive of these drugs.
Obamacare enrollees might be using the more expensive of these drugs.
Mario Tama / Getty Images News

Early Obamacare enrollees are using costly specialty drugs at higher rates than people on traditional health plans, according to a preliminary look from the drug-management company Express Scripts. But experts caution it's too early to pull a long-term trend from the data.

The concern is that, if the trend does hold up, the data could indicate that Obamacare enrollees tend to be sicker and, therefore, more expensive for insurance companies and the federal government.

Specifically, Express Scripts found 1.1 percent of total prescriptions on exchange plans during January and February went to specialty medications, which treat major health issues like HIV, depression, pain, and seizures. In comparison, specialty medications made up only 0.75 percent of prescriptions in commercial health plans. Both those numbers seem small, but they equate to a 47 percent difference that could make Obamacare enrollees much more expensive to cover.

Larry Levitt, senior vice president at Kaiser Family Foundation, warns the numbers are very much preliminary.

"Everyone expected that the earliest enrollees were more likely to be sicker," he says. "These are people who already had coverage or absolutely knew they needed coverage and were previously locked out of the market because of a preexisting condition. It also included people in particular coming from high-risk pools."

Levitt argues it's very unlikely someone who's HIV-positive, for example, is going to decline affordable health insurance when given the opportunity. Meanwhile, healthier people might not feel the need to sign up for Obamacare until some other factor — say, the individual mandate — pressures them to get health insurance.

So the sicker people, Levitt says, probably signed up earlier in the open-enrollment period, while the healthier people signed up closer to the March 31 deadline — after the time span Express Scripts looked at.

It's possible the full long-term trend won't come to light until a few years of enrollment in the exchanges. For the first year, many insurance companies padded their premiums in expectation of a sicker pool and higher costs. But experts expect uptake among healthier people to increase over time; if that doesn't happen, health-care costs — and premiums — could increase.

But since Express Scripts's analysis looked at two months before Obamacare's enrollment period closed, Jenna Stento, senior manager at Avalere Health, says it's hard to predict whether healthier people will eventually — or already did — sign up for Obamacare.

It also might seem counter-intuitive to worry about sicker people getting health coverage they need, Levitt and Stento acknowledge. But if there are too many sick people in the insurance pool, costs could reach a point where those sick people are once again priced out — and not getting the care they need as a result.