Most Medicaid beneficiaries are willing to pay for healthcare coverage and are more proactive about their care when they do, according to an analysis by Anthem's Public Policy Institute.
The study has prompted the insurer, one of the largest in the nation, to become the first plan to formally support conservative Medicaid expansion.
Patient advocates have said cost-sharing elements used by some conservative governors in hold out states could push lower-income, often sicklier people out of coverage.
Anthem studied Indiana's Healthy Indiana Plan (HIP) 2.0 population. Of the 387,000 enrolled on the program, 43% are covered by Anthem, giving it the largest footprint in the program.
Indiana launched HIP 2.0 in January 2015 under a waiver agreement with the CMS. It has two different levels of coverage for residents with incomes up to 138% of the federal poverty line—one called HIP 2.0 Plus that includes dental and vision benefits and one called HIP Basic that does not.
As a condition of coverage, individuals are required to pay anywhere from $1 to $25 a month, depending on their income level, into a health savings account. If they are above the federal poverty level, they can be locked out of coverage for six months if they skip their contributions for two consecutive months. If a person is below the poverty level and doesn't pay, he or she will be placed in the Basic coverage plan.
Based on data collected by the health plan, nearly 70% of the health plan's members enrolled in HIP are choosing to pay for the Plus option, including 65% of members with incomes less than or equal to 23% of the FPL, which equates to roughly $228 in monthly income for an individual.
Plus members are more likely to get preventive screenings than Basic members, according to Anthem. For instance around 39% of Plus members received a breast cancer screening compared to 21% of Basic members, while 27% of Plus members obtained a cervical cancer screening compared to 15% Basic member's ER use among Plus members is 21% lower than use among basic members.
The findings “suggests that even modest member contributions such as those required under HIP Plus, when designed appropriately, can positively influence how members think about and access care,” said Jennifer Kowalski, vice president at Anthem's Public Policy Institute.
That has lead Anthem to actively support conservative expansion in hold-out states, according to Kristen Metzger, president of Anthem's Medicaid health plan in Indiana.
Indiana is currently asking the CMS to continue to allow it to charge premiums. A new governor could come in as junk the waiver, as the one in Pennsylvania did, and the result would be disheartening, Metzger said.
“It would be a step backwards for us, since we are seeing it start to transform how Hoosiers are accessing their healthcare,” Metzger said.
But patient advocacy groups disagree.
“The people in Basic aren't doing to that great,” said Judy Solomon, a vice president for health policy at the left-leaning Center on Budget and Policy Priorities. “Why aren't they getting preventive care and what is Anthem doing to try to reach them?”
Anthem's report also underscores how confusing these expansions can be compared to straightforward ones.
For instance, members in HIP 2.0 are contacting the health plan almost seven times more often than are members in the traditional Medicaid. Anthem says that shows people becoming more active in participating in their healthcare.
“They're calling the plan all the time because they don't understand how their accounts work,” said Andrea Callow, a Medicaid policy analyst at consumer group Families USA.
Anthem's report further emphasizes the need for a federal evaluation of HIP 2.0, which is something the state has been fighting against.
Such a report could better outline participation rate for Indiana expansion versus other states that didn't charge premiums, according to Joan Alker, executive director of the Georgetown Center for Children and Families.