Here's The Procedure Obamacare Enrollees Had Been Putting Off

A lot of Obamacare enrollees have a new spring in their step.

Knee-replacement surgery was the most disproportionately popular "preference-sensitive" health care treatment that people who are newly insured under the Affordable Care Act received in the first few months of 2014, according to a new analysis from the Society of Actuaries.

Preference-sensitive care, to untangle the jargon, is health care that you can put off without inviting a crisis, even if you might like to get it. A visit to the emergency room visit or to the doctor to manage a chronic condition like diabetes is not preference-sensitive. Getting your knee replaced, on the other hand, is more optional.

Knee-replacement surgery, surgery to relieve lower-back pain, and upper endoscopies (which allow doctors to check for digestive and other problems in the esophagus, stomach, and small intestine) were unusually popular among the people who got insurance for the first time through Obamacare.

"These results show how giving health insurance to people who lacked it before can improve their quality of life," Larry Levitt, vice president of the Kaiser Family Foundation, said in an email.

The authors studied insurance-claims data in Kansas, which is generally, though not perfectly, similar in demographics to the United States overall, to reach its conclusions. They compared claims from the newly insured to those who already had coverage and measured which services the former population had used comparatively more often. It isn't a perfect system—the actual number of knee replacements is relatively small and therefore not a statistically precise measure—but it offers a glimpse into where the pent-up demand is within the health care system.

The findings make some sense. This is the kind of care that would be very expensive if you were paying out of pocket, and it treats conditions that you could probably live with. A balky knee or a sore back isn't necessarily going to debilitate you (at least not for a while), and so you aren't going to pay tens of thousands of dollars of your own money to fix it. But once you have insurance to cover it, those are obvious things to have treated.

Some of the other procedures that the previously uninsured were forgoing, though, are a bit more worrisome. Upper endoscopies help diagnose cancers of the esophagus, pancreas, and stomach, for example. Other disproportionately popular claims for the newly insured included MRI and CT scans, which also identify cancers and other serious conditions.

Gallstone removal was particularly popular among new Obamacare enrollees, which also computes. Surgery is the more expensive, but also more permanent, treatment.

The findings also provide some important context for the premiums that insurers propose for ACA plans in 2016, Levitt said. For the first time, they'll be basing their rates on real claims data for this new Obamacare population. But, as Levitt and the study's authors point out, this spike seen in preference-sensitive treatment typically doesn't last forever. People get the care they had been putting off, but then they start to become more like regular health care customers.

"Just because new enrollees used more services initially doesn't mean that will necessarily be true looking ahead," Levitt said. "This study may give insurance regulators some evidence to push back on insurers that are proposing big rate increases for 2016 based on how much health care enrollees used in 2014."

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