If more people have health insurance, then more diseases will be diagnosed.
That means more people in the United States will be at doctors’ offices and clinics, receiving treatment and taking medication.
That does cost more money, but the short-term spike in healthcare expenses will be more than offset by long-term reductions in costs.
That’s the equation expressed in a new report published in the journal Health Affairs.
For their study, researchers from the Harvard T.H. Chan School of Public Health looked at data from a 10-year Affordable Care Act (ACA) projection published by the Congressional Budget Office (CBO).
According to the researchers, if the number of uninsured, non-elderly Americans was reduced by half, there would be 1.5 million newly insured individuals diagnosed with one or more chronic conditions.
About 659,000 of those newly insured individuals would be able to achieve control of at least one condition due to their earlier diagnosis.
“Our study suggests that insurance expansion is likely to have a large and meaningful effect on diagnosis and management of some of the most important chronic illnesses affecting the U.S. population,” said Joshua Salomon, Harvard T. H. Chan professor of global health, in a statement.
A total of 28,157 people participated in the National Center for Health Statistics’ National Health and Nutrition Examination Survey (NHANES) from 1999 to 2012. They ranged from 20 to 64 years in age.
Researchers noted that insured people had a significantly higher probability of being diagnosed with a chronic disease than people without insurance.
In fact, people with insurance are 14 percent more likely to be diagnosed with diabetes and high cholesterol. They’re also 9 percent more likely to have high blood pressure detected.
In those already diagnosed with a chronic condition, having health insurance meant having a higher probability of being properly treated.
Paying Now to Save Later
If more people enroll in health insurance, what does it mean for society in regards to battling chronic conditions such as high cholesterol and diabetes?
Dr. Vivian Ho, director of the Center for Health and Biosciences at Rice University’s Baker Institute for Public Policy, said that providing people with insurance raises healthcare spending and increases expenses under the Affordable Care Act (ACA).
The costs, however, could be worth it.
“Long-term studies show that treating cholesterol and high blood pressure increases life expectancy,” she told Healthline.
That doesn’t mean that preventive medicine stops heart attacks and strokes, though. Those can happen even with treatment, especially as people live longer, Ho said.
Aging, Ho said, can also result in higher healthcare spending.
However, she added, many treatments for high cholesterol, blood pressure, and diabetes have been shown to be cost-effective. In those cases, the cost per year of life can be less than it would otherwise have been without treatment.
Salomon said the U.S. healthcare industry needs to be ready to treat all these new diagnosed cases.
“There is urgent need to ensure that the U.S. healthcare system is equipped to provide high quality care for large numbers of people who will be newly diagnosed with a chronic disease,” said Salomon.
Hurdles to ACA Enrollment
So, with the better care and lower long-term costs, why doesn’t everyone sign up?
Aside from the well-documented challenges of actually signing up, some Americans still refuse to try.
Dr. Robert Wergin, president of the American Academy of Family Physicians, said the country needs to encourage more people to enroll.
Wergin is a private practice physician based in Nebraska. He told Healthline he has seen firsthand how patients with pre-existing conditions can now receive coverage without having to pay an exorbitant amount of money for services.
“Some people are just not aware of it,” Wergin said.
Cultural issues also dissuade people from signing up. Others just do not seek out medical care.
Dr. Gerard Anderson, director of the Center for Hospital Finance and Management at Johns Hopkins University, said there are two main groups that do not have health insurance coverage now.
The first is undocumented individuals living in the United States. The second are people who believe the ACA is bad for the country or that they will not need coverage under it.
“Over time as they see that the ACA is here to stay, and their friends and relatives actually do get sick, they will start to enroll,” Anderson told Healthline.
As for the thought that costs could rise if the additional 1.5 million people mentioned in the report enroll in an ACA program, Anderson doesn’t think that will be the case.
“The sickest people have already signed up,” he said.
Looking at Incentives
Money is undoubtedly a hurdle to driving sign-ups.
Ho noted a report from the Urban Institute, which found that 1 in 10 non-elderly adults in the U.S. are uninsured.
The report stated that 25 percent of people without health insurance have incomes below the federal poverty level (FPL) and live in states that did not elect a Medicaid expansion under the ACA.
Ho said others who are between 200 and 399 percent of the FPL qualify for some subsidy, but the financial help is less than for those between 100 and 199 percent of the FPL.
“They therefore face relatively high premiums for people living on a limited budget, and they get less help with out-of-pocket medical expenses,” Ho explained. That “may discourage them from buying insurance in the marketplace.”