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Topic: Express Scripts Study

OCare Study: Obama’s TD Dance Premature

After President Obama’s enrollment deadline touchdown dance, some Democrats have been trying to act as if the health-care law to which they have tied their political fortunes is a grand success. Many in the news media have followed their lead and concluded that the claim that 7.1 million Americans had signed up for the scheme by the April 1 deadline meant that doubts about its viability or popularity were put to rest. The fact that perhaps as many as 20 percent of those being counted as happy ObamaCare customers haven’t paid their premiums—and thus aren’t covered—is being ignored. So is the fact that it is entirely likely that the vast majority of those included in the 7.1 million figure were not previously uninsured, meaning that many were forced out of their old, preferred plans and are now paying more for coverage they didn’t want.

But a new study from Express Scripts, the large pharmacy benefits-managing company, reveals something else that ought to depress those liberals throwing victory parties for the success of the misnamed Affordable Care Act: those signing up for ObamaCare appear to be older, sicker, and more dependent on expensive, specialty drugs than the average person covered by employer-based health insurance. Though it’s possible that the last-minute surge of signups may reduce the preponderance of sick people among those covered by ObamaCare, the results among the early enrollees show that the expectation that the program will be able to pay for itself is almost certainly misplaced. Moreover, the imbalance in favor of the sick means that the price of insurance may go up even higher next year than had already been predicted. While Democrats may be relieved that those price increases won’t go into effect before November, the country may need to brace itself for a tsunami of outrage in 2015 after an ObamaCare-fueled hike sends insurance costs skyrocketing.

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After President Obama’s enrollment deadline touchdown dance, some Democrats have been trying to act as if the health-care law to which they have tied their political fortunes is a grand success. Many in the news media have followed their lead and concluded that the claim that 7.1 million Americans had signed up for the scheme by the April 1 deadline meant that doubts about its viability or popularity were put to rest. The fact that perhaps as many as 20 percent of those being counted as happy ObamaCare customers haven’t paid their premiums—and thus aren’t covered—is being ignored. So is the fact that it is entirely likely that the vast majority of those included in the 7.1 million figure were not previously uninsured, meaning that many were forced out of their old, preferred plans and are now paying more for coverage they didn’t want.

But a new study from Express Scripts, the large pharmacy benefits-managing company, reveals something else that ought to depress those liberals throwing victory parties for the success of the misnamed Affordable Care Act: those signing up for ObamaCare appear to be older, sicker, and more dependent on expensive, specialty drugs than the average person covered by employer-based health insurance. Though it’s possible that the last-minute surge of signups may reduce the preponderance of sick people among those covered by ObamaCare, the results among the early enrollees show that the expectation that the program will be able to pay for itself is almost certainly misplaced. Moreover, the imbalance in favor of the sick means that the price of insurance may go up even higher next year than had already been predicted. While Democrats may be relieved that those price increases won’t go into effect before November, the country may need to brace itself for a tsunami of outrage in 2015 after an ObamaCare-fueled hike sends insurance costs skyrocketing.

The problem here is that having established ObamaCare as an entitlement that they believe can never be revoked, the administration has stuck the health-care system with a situation that is a financial nightmare. As the New York Times reports:

Julie Huppert, vice president for health care reform at Express Scripts, said she expected to see the picture change as the year progressed. But she said this early glimpse was crucial for insurers, which were already setting their rates for next year.

“There may not be enough time to assess much more than this,” she said.

The study found that six of the 10 most costly drugs in the marketplace plans, in terms of total spending, were specialty drugs, in contrast to four of the top 10 drugs in employer plans. The higher use of specialty drugs could point to additional health care costs, some said.

“The medication is only the tip of the iceberg,” said Daniel N. Mendelson, chief executive of the consulting firm Avalere Health. “What goes along with that is a need for physician visits and, often, hospitalizations associated with complications from the conditions.”

In addition to finding increased use of drugs to treat pain, seizures and depression, the study also found that 6 in every 1,000 prescriptions in the marketplace plans were for drugs that treat H.I.V., a number that was nearly four times the figure among those with employer coverage.

While the president and his supporters may take credit for making it easier for those with pre-existing conditions to gain coverage, if enough young and healthy consumers have not been suckered into signing up, insurance companies are going to be stuck with paying for all those sick and elderly Americans who have been shunted into the program. That means they are going to have to drastically raise prices the next chance they get.

Just as bad is the sticker shock many of those who are now part of the ObamaCare program are experiencing when they go to the pharmacy:

Some consumers who signed up for marketplace plans said they were shocked when they made their first visit to the pharmacy this year. Lawrence Cwik, a photographer in Portland, Ore., said his monthly contribution for Atripla [an H.I.V. drug] increased to $1,018, from $40, when he switched to a new marketplace plan after his old plan was canceled. Both were through Regence BlueCross BlueShield of Oregon.

Mr. Cwik, 55, said he complained and the insurer agreed to reduce his out-of-pocket payment to $40 for the rest of this year, “but beyond that, I’m pretty much out of luck.”

That scenario is being played out across the country countless times this year as those who lost previous coverage as a result of ObamaCare’s implementation pay the price of the president’s great “success.”

Democrats and even many Republicans long believed that once it went into effect, ObamaCare would become as beloved as Social Security or Medicare. But despite the White House celebrations about the enrollment figures, that assumption is still unfounded. The long-term costs of this law for many Americans will be devastating. The more people experience it, the less popular it is likely to get.

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