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Report: New Health-Law Medicaid Enrollees May Need Intensive Medical Care

More than 3 million will have inadequately controlled chronic conditions (June 23)

Under the Patient Protection and Affordable Care Act (PPACA), many low-income, uninsured adults will soon be eligible for Medicaid. Although these individuals tend to be healthier than patients already enrolled in Medicaid, they will likely need prompt care to deal with undiagnosed and uncontrolled conditions, according to a new study in JAMA.

Published predictions about new Medicaid enrollees under the PPACA have ranged from their likely being mostly nondisabled healthy adults to their having high levels of disability and multiple comorbidities.

To determine the health care needs and health risks of uninsured adults who could be eligible for Medicaid coverage under the PPACA, researchers at the Centers for Disease Control and Prevention (CDC) and The Urban Institute analyzed health conditions among a nationally representative sample of 1,042 uninsured adults aged 19 through 64 years with income no more than 138% of the federal poverty level, compared with 471 low-income adults currently enrolled in Medicaid. The data were obtained from the National Health and Nutrition Examination Survey (NHANES) 2007–2010.

The researchers found that patients newly enrolled in Medicaid under the PPACA will differ significantly from current Medicaid enrollees. Compared with those already on Medicaid, uninsured adults were less likely to be obese and sedentary and less likely to report a physical, mental, or emotional limitation. They also were less likely to have chronic conditions, such as hypertension, hypercholesterolemia, or diabetes. However, if they had these conditions, uninsured adults were less likely to be aware of them and less likely to have them controlled.

The number of currently uninsured adults with inadequately controlled chronic conditions could be as high as 3.5 million, the authors estimate. Because many of these people have not seen a physician in the past year and do not have a place they usually go for routine health care, they are likely to need intensive medical care on first enrolling in Medicaid.

One-third of uninsured adults were obese; half were smokers; and one-quarter indicated that their health was no better than fair or poor — “all factors that could require attention from clinicians,” the authors said.

Source: JAMA; June 23, 2013.

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