Association for Public Policy Analysis & Management

Research Objective: To examine administrative claims data for evidence of pent-up demand for health care among newly-insured adults in individual and family health insurance plans and Medicaid as health reform rolls out.  This study contributes important evidence on pent-up demand as claims data provide more details on a broader set of health care interactions (e.g. primary care visits, diagnostic tests, prescriptions) than does hospital or survey data.

Study Design: We use administrative claims data to examine patterns in health care use for 6 months after enrollment for those enrolled after the 2014 ACA implementation (January 2014-July 2014).  In particular, we examine the number of preventive visits; new patient visits; other primary care and specialty care visits; diagnostic tests; hospitalizations and whether they were potentially preventable; emergency department use and its appropriateness; pharmacy utilization; and per-member, per-month average costs.  Our analytic methods include logit models for binary variables, Poisson models for count variables, and two-part models for cost outcomes. 

Population Studied: The sample includes Minnesota adult (age 18-64) members of a regional health plan who enrolled for the first time during the ACA roll-out in early 2014. We focus on 2 population groups: 1) members who enrolled in Medicaid during Minnesota’s 2014 Medicaid expansion, and 2) members who enrolled in individual and family plans through the state-based health insurance marketplace (MNsure) or direct purchase.  We define newly enrolled as not having coverage with this insurer in the 12 months prior to enrollment, and thus may include some individuals who are switching insurance companies.  We compare the newly enrolled to comparable groups with on-going coverage. 

Principal Findings: Preliminary findings indicate that new Medicaid enrollees in 2014 have high levels of new patient visits, new prescriptions and diagnostic testing, consistent with pent-up demand.  In contrast, new individual and family plan enrollees have lower health care utilization than those with ongoing coverage. 

Conclusions: These findings suggest that long-term costs of the health insurance expansion under ACA may be lower than expected, which could signal lower premiums that in turn affect affordability and coverage.  

Implications for Health Policy: Findings from Minnesota’s Medicaid expansion can inform other states’ decisions about expansion and its costs.