Milliman compared Indiana's HIP population against the typical commercial population and found much higher inpatient services, ER visits, and pharmacy costs. Milliman discovered the HIP population was more likely to have chronic diseases, such as asthma, depression, and diabetes, than the typical commercial population. The first people to enroll in the program in the first few months had a higher morbidity rate.
Milliman's research found that inpatient, outpatient, pharmacy, and physician expenditures peaked around the second and third months and then decreased over the year. This shows that the sickest, previously uninsured Hoosiers jumped at the new offering and received care immediately. Those in better health waited until later in the year to join.
Milliman found that inpatient use decreased in the seventh to ninth months of enrollment, outpatient costs dropped after the third month, and pharmacy costs increased steadily in the first nine months.
Damler warns that any health reform plan should take into account anti-selection. He also suggests that an individual mandate, which is in place in Massachusetts and has been debated as part of federal health reform, would have brought a "broader cross-section" to HIP from the start. He suggests that any health reform plan would be "difficult to protect against anti-selection in insurance without the use of some type of mandates."
Damler says an individual mandate coupled with personal responsibility and spending "appropriate levels" at the initial periods are keys to health reform's success.
Mandates have been debated by federal lawmakers, but there has not been broad support for requiring health insurance for all Americans.
However, as the Milliman study shows, if you are going to bring the healthy into the health insurance pool, policymakers will need to find ways to woo them into the water. Without demanding they buy coverage, don't expect the healthy (especially the young and healthy) to dip their toes into the health insurance waters.