Expanding health insurance causes moral hazard. Patients who bear a lower share of cost will inevitably use more health care serices. On the one hand, this increases the cost of the health care system; on the other hand, the patients who receive the additional care likely have better health outcomes.
However, which services will patients who are newly insured through the Affordable Care Act (ACA) choose to use? One way to predict this is to examine what happened after Massachusetts expanded their health insurance coverage (i.e., Romney Care). It is likely that newly insured patients use more elective surgery. WonkBlog reports:
A new study published in JAMA Surgery suggests the immediate effects of the coverage expansion will be an increase in elective surgeries aimed at improving a person’s quality of life — think of things like knee replacements and back surgeries — as opposed to surgery immediately addressing life-saving conditions…
Michigan researchers examined surgery rates for people ages 19 to 64 between 2003 and 2010, which captured the experience just before and after the Massachusetts coverage expansion took effect in 2007. Comparing surgery rates to those in New York and New Jersey, the researchers found the coverage expansion in Massachusetts increased elective surgeries 9.3 percent three years after the law took effect. The increase was more dramatic among nonwhite populations (19.9 percent), who face disparities in care.
- Ellimoottil C, Miller S, Ayanian JZ, Miller DC. Effect of Insurance Expansion on Utilization of Inpatient Surgery. JAMA Surg. Published online July 02, 2014. doi:10.1001/jamasurg.2014.857