Government had ACA Costs Wrong

Dave Mosley


by Dave Mosley



The Feds had expected, in their estimates, that the newly insured population would behave in a manner commensurate with the previously insured population.  They have not.  In addition to a backlog of health needs that were addressed subsequent to obtaining insurance, the new population was comprised largely of individuals inexperience with acting in manner similar to those who were previously insured.


Are they taking advantage of primary care instead of using emergency rooms, as insured folks do?  No, not really.


Are they compliant with physician guidance?  No, not really.


Are they adopting new behaviors that lead to improved health and wellness?  Again, not so much.


A significant percentage of the increased cost per beneficiary is also attributable to the failure of well, young individuals to sign-up.


I have heard from several young people…”no, I am not signing up and I am claiming more deductions than necessary so that I never get a refund….and the refund is the only way the Feds can get a penalty from me.”  OR, “there are no pre-existing exclusions, so I will wait until I am very sick and I will sign-up then.”


The Feds calculations for per member cost included a huge wave of young, healthy folks signing up and this hasn’t happened.


Dave Mosley is a Managing Director and the State Practice Leader for Navigant’s Government Healthcare Solutions (GHS). He assists Medicaid, human services, and elected leaders to navigate regulatory channels and to apply best practices to improve organizational performance. He is a recognized public speaker, has been published in trade journals, and is frequently called upon as a resource to elected officials at the state and Federal levels.


For more about Dave, check out his LinkedIn profile.


Article reprinted with kind permission from author.