Running head: CASE STUDY 5 1

Capstone G: Capstone Case G: Changes in Non-Group Coverage Under the Affordable

Care Act

John Tata

HCM 530

Saint Leo University

CASE STUDY 5 2

In order to provide low-cost healthcare and provide insurance to the uninsured

U. S citizens, the Affordable healthcare act (ACA) was implemented in 2010. ACA had

another important goal which was access to quality healthcare services for people that

were covered under insurance (Knickman, Jonas, & Kovner, 2015, Hong, Holcomb,

Bhandari, & Larkin, 2016). President Obama was the one to sign the Affordable Care Act

in order to make sure that the Americans enjoy secure, stable and cost-effective health

insurance (CDC. Gov., 2019).

Question 1

Percentage change rate = change in value / initial value x 100

Or

New value – old value/new value x 100

Hence,

Modeled percentage change in covered lives

The = total population for no-group coverage under ACA

– total population for non-group coverage under existing law/ total population for non-group

coverage under existing law x 100 (Fleming, 2008).

For example, for ages under 19, the percentage change in lives = 71054-32480/32480 x 100

Non-group under current Non-group under ACA Percentage change

law

Age Number Average Number Average Number Average

monthly monthly
cost cost

Under 19 32480 $171 71054 $189 118.76%

19-24 34787 $190 53464 $186 53.69%

CASE STUDY 5 3

25-34 39606 $255 81396 $322 105.51%

35-44 31579 $310 76544 $380 142.5%

45-54 42976 $497 79242 $688 84.4%

55 or over 58898 $533 80319 $896 36.4%

Question 2.
Modeled percentage cost in average monthly cost = total population for non-group coverage
under the ACA - total population for non-group coverage under the current law/ total population
for non-group coverage under the current law x 100.
For example, modeled percentage cost in average monthly cost for under 19 age group
= 189-171/171 x 100
= 10.52%

Non-group under current Non-group under ACA Percentage change

law

Age Number Average Number Average Number Average

monthly monthly
cost cost

Under 19 32480 $171 71054 $189 118.76% 10.52%

19-24 34787 $190 53464 $186 53.69% 2.10%

25-34 39606 $255 81396 $322 105.51% 26.27%

35-44 31579 $310 76544 $380 142.5% 26.27%

45-54 42976 $497 79242 $688 84.4% 26.27%

55 or over 58898 $533 80319 $896 36.4% 68.10%

Question 3
CASE STUDY 5 4

Increase in the percentage of covered lives can be confirmed if the number is positive and higher
than the previously estimated value. According to the table, the age group 35-44 has the highest
increase in modeled percentage change at 142%.
Question 4
As per the table, the age category with the highest increase in monthly costs is 55 or older at
68%.

Question 5
Modeled percentage change in covered lives

Age Number Average number Average Number Average

monthly monthly monthly
cost cost cost
Under 19 31952 $167 71054 $189 122%
19-24 34197 $172 53464 $186 56%
25-34 36993 $219 81396 $322 120%
35-44 28983 $227 76544 $380 164%
45-54 37487 $322 79242 $688 111%
55 or over 45795 $384 80319 $896 75%

Question 6

Modeled percentage change in average monthly costs

Age Number Average number Average Number Average

monthly monthly monthly
cost cost cost
Under 19 31952 $167 71054 $189 122% 13%
19-24 34197 $172 53464 $186 56% 8%
25-34 36993 $219 81396 $322 120% 47%
35-44 28983 $227 76544 $380 164% 67%
45-54 37487 $322 79242 $688 111% 114%
55 or over 45795 $384 80319 $896 75% 133%

Question 7

The table suggests that the age category of 35-44 has the highest increase in the modeled

percentage for covered lives i. e., 164% (Fleming, 2008).

Question 8
CASE STUDY 5 5

The table provides that age category with the largest increase in the monthly costs is 55 or older
population at about 133% which is considered to be at high risk.

Question 9

Modeled percentage change in lives (calculated on the formula given in above questions)

Non-group under current Non-group under ACA Percentage change

law
Health number Average number Average number Average
status monthly monthly monthly
cost cost cost
excellent 206978 $281 355079 $310 71.55%
good 27069 $686 71065 $668 208.81%
fair 5500 $906 12777 $2556 132.30%
poor 770 $3992 3099 $4818 302.46
total 240317 $353 442020 $464 83.93

Question 10
Modeled percentage change in average monthly costs

Non-group under current Non-group under ACA Percentage change

law
Health number Average number Average number Average
status monthly monthly monthly
cost cost cost
excellent 206978 $281 355079 $310 71.55% 10.32%
good 27069 $686 71065 $668 208.81% -2.62%
fair 5500 $906 12777 $2556 132.30% 182.11%
poor 770 $3992 3099 $4818 302.5% 20.69%

total 240317 $353 442020 $464 84% 31.44%

Question 11
The table represents that the health status group with the highest increase in modeled percentage
change for covered lives is 302%, which is the poor status group

Question 12
The table reflects that the health status group with the highest increase in monthly cost is fair at

182%, which includes the high-risk group (Flemming, 2008).

CASE STUDY 5 6

Question 13
Modeled percentage in the covered lives

Non-group under current Non-group under ACA Percentage change

law
Health number Average number Average number Average
status monthly monthly monthly
cost cost cost
excellent 192143 $277 355079 $310 84.79%
good 19863 $500 71065 $668 257.7%
fair 3222 $582 12777 $2556 296.55%
poor 179 $149 3099 $4818 1631.28%
total 215407 $258 442020 $464 105.20%

Question 14
Modeled percentage change in average monthly costs

Non-group under current Non-group under ACA Percentage change

law
Health number Average number Average number Average
status monthly monthly monthly
cost cost cost
excellent 192143 $277 355079 $310 84.79% 36.56%
good 19863 $500 71065 $668 257.7% 33.6%
fair 3222 $582 12777 $2556 296.55% 339.17%
poor 179 $149 3099 $4818 1631.28% 3133.55%
total 215407 $258 442020 $464 105.20% 79.84%

Question 15
The calculations done in the table show that poor status health group has the highest increase in
modeled percentage for covered lives, i. e., 1631% approximately.

Question 16
Our calculations suggest that the poor status health group had the highest increase in monthly
costs, which is 3133. 55%.

Question 17
Modeled percentage in covered lives
Uninsured under law Remain uninsured under Percentage change
law
CASE STUDY 5 7

age number Average number Average number Average

monthly monthly monthly
cost cost cost
Under 19 76268 $80 45420 $66 -40.44
19-24 128940 $101 34711 $104 -73.07
25-34 139767 $118 62442 $82 -55.32
35-44 104605 $174 46792 $108 -55.26
45-54 84871 $183 33814 $125 -60.15
55 or 68197 $342 20585 $255 -69.81
above

Question 18
Modeled percentage in average monthly costs

Uninsured under law Remain uninsured under Percentage change

law

age number Average number Average number Average

monthly monthly monthly
cost cost cost
Under 19 76268 $80 45420 $66 -40.44 -17.5%
19-24 128940 $101 34711 $104 -73.07 2.97%
25-34 139767 $118 62442 $82 -55.32 -30. 50%
35-44 104605 $174 46792 $108 -55.26 -37.9%
45-54 84871 $183 33814 $125 -60.15 -31.7
55 or 68197 $342 20585 $255 -69.81 -25.43
above

Question 19
The population within the age group 19-24 is estimated to have the highest fall in uninsured
individuals at -73
Question 20
The largest decrease in monthly average costs is -38% for age group 35-44
Question 21
Modeled percentage change in covered lives
Uninsured under current Remain uninsured under Percentage change
law ACA
Health NUmber Average number Av. number Av.
status monthly Monthly Monthly
cost cost cost
Excellent 463762 $103 199144 $91 -57.05% $
CASE STUDY 5 8

good 108637 $253 37128 $164 -65.82 $

fair 24637 $413 6237 $268 -74.68 $
poor 5611 $1295 1255 $279 -77.63 $

Question 22

Modeled percentage change in average monthly costs

Uninsured under current Remain uninsured under Percentage change

law ACA
Health NUmber Average number Av. number Av.
status monthly Monthly Monthly
cost cost cost
Excellent 463762 $103 199144 $91 -57.05% -11.65%
good 108637 $253 37128 $164 -65.82 -35.17%
fair 24637 $413 6237 $268 -74.68 -35.10%
poor 5611 $1295 1255 $279 -77.63 -78.5%

Question 23
The health group that was estimated to show the largest decline in the uninsured number is the
group with poor health status at a value of -77%.

Question 24
The health status group showing the greatest decrease in average monthly cost is poor at -78.5 %.
Question 25
In order to estimate the morbidity change of the uninsured group after ACA implementation, we
will make use of incidence and prevalence rate for each group to make a comparison. The
incidence rate can be calculated as number of new persons uninsured/ total number of population
at risk x 100, 000. The prevalence rate for each group can be given by % of uninsured
population/ total number of individuals in a population x 100. Thus, the incidence rate per group
can be calculated as

Group Incidence rate

Excellent 463762-199144/602447 +243764 x 100 =
31.27%
good 108634-37128/602447 +243764 x 100 =
8.5%
Fair 24637-6237/602447 +243764 x 100 = 2.17%
poor 5611-1255/602447 +243764 x 100 = 0.51%
CASE STUDY 5 9

The incidence rates reveal that the poor health status group has the greatest decrease in incidence
at 0.51% and the group with excellent health stats has the highest incidence rate for average
morbidity change (31.2%). Thus, the incidence rate ranges between excellent (31.2%) to the poor
(0.51%).

Prevalence for each group under current law can be estimated as

Group Prevalence rate

Excellent 463762/602647x 100 = 77%
good 108637/602647 x 100 = 18%
Fair 24637/602647 x 100 = 4%
poor 5611/ 602647 x 100 = 0.93%

Prevalence for each group under ACA can be estimated as

Group Prevalence rate
Excellent 199144/243764 x 100 = 82%
good 37128/243764 x 100 = 15%
Fair 6237/243764 x 100 = 3%
poor 1255/243764 x 100 = 0.514%

Morbidity rate formula = No. of new cases of uninsured population/ total number of individuals
in a population x 100
Morbidity rate of uninsured under current law
Group Morbidity rate
Excellent 463762/662906 x 100= 70%
good 108637/1123765 x 100= 10%
Fair 24637/30874 x 100= 80%
poor 5611/6866 x 100= 82%

Morbidity rate of uninsured under ACA

Group Morbidity rate
Excellent 199144/662906 x 100= 30%
good 37128/1123765 x 100= 3.3%
Fair 6237/30874 x 100= 20%
poor 1255/6866 x 100= 18%

Question 26

Percentage change in lives

CASE STUDY 5 10

Covered by Medicaid Covered by Medicaid Percentage change

under current law under ACA
Age NUmber Average number Av. number Av.
monthly Monthly Monthly
cost cost cost
Under 19 438090 $184 435615 $189 -.56%
19-24 61895 $690 1425715 $405 130.34%
25-34 82473 $726 106634 $613 29.29%
35-44 77118 $472 88701 $503 15.01%
45-54 46034 $832 64810 $783 40.78%
55 or over 33034 $976 78533 $1047 137.78%

Question 27
Covered by Medicaid Covered by Medicaid Percentage change
under current law under ACA
Age NUmber Average number Av. number Av.
monthly Monthly Monthly
cost cost cost
Under 19 438090 $184 435615 $189 -.56% 2.71%
19-24 61895 $690 1425715 $405 130.34% -41.30%
25-34 82473 $726 106634 $613 29.29% -15.56%
35-44 77118 $472 88701 $503 15.01% 6.56%
45-54 46034 $832 64810 $783 40.78% -5.88%
55 or over 33034 $976 78533 $1047 137.78% 7.27%

Question 28
The age group 55 or above has the highest increase in Medicaid enrollees (137.78%).
Question 29
The population within the age group 19-24 has the highest decrease in average monthly costs.
Question 30

Covered by Medicaid Covered by Medicaid Percentage change

under current law under ACA
Health NUmber Average number Av. number Av.
status monthly Monthly Monthly
cost cost cost
Excellent 569235 $228 700263 $238 23.01%
Good 123176 $591 15334 $649 24.49%
Fair 37340 $1284 51173 $1258 9.81%
Poor 8894 $4443 12099 $4349 36.03%
CASE STUDY 5 11

Question 31

Percentage change in the average monthly cost

Covered by Medicaid Covered by Medicaid Percentage change
under current law under ACA
Health NUmber Average number Av. number Av.
status monthly Monthly Monthly
cost cost cost
Excellent 569235 $228 700263 $238 23.01% 4.38%
Good 123176 $591 15334 $649 24.49% 9.81%
Fair 37340 $1284 51173 $1258 9.81% -2.02%
Poor 8894 $4443 12099 $4349 36.03% -2.11

Question 34

Morbidity rate formula = no. of new cases covered by Medicaid/ total number of individuals in a
population x 100

Covered by Medicaid under current law

Group Morbidity rate

Excellent 569235/1269489 x 100 = 44.83%
Good 123176/276530 x 100 = 44.54%
Fair 37640/88513 x 100 = 42.52%
Poor 8894/20993 x 100 = 42.36%

Covered by Medicaid under ACA

Group Morbidity rate
Excellent 700263/1269489 x 100 = 55.16%
Good 153354/276530 x 100 = 55.45%
Fair 51173/88513 x 100 = 57.81%
Poor 12099/20993 x 100 = 57.63%

The morbidity rate in a population of Medicaid covered under current law to the population of
Medicaid covered under ACA in different groups is reported as

Health status Change in morbidity rate (%)

Excellent 45-55
Good 45-54
Fair 43-58
Poor 43-57
CASE STUDY 5 12

Question 35
Morbidity rate
Uninsured under current law excluding high 602647-240317/602647x 100=
risk 362330/602647 x 100 = 60%
Uninsured after ACA excluding high risk 276034-442021/276034 x 100= -
165987/276034 x 100= -60%
Insured Under current law excluding high risk 738645-240317/738645 x 100=
498328/738645 x 100= 67%
Insured under ACA excluding high risk 474868/916889 x 100= 52%.

Question 36
Morbidity rate
Uninsured under current law excluding high 602647/878681 x 100= 68.58% or 69%
risk
Uninsured after ACA excluding high risk 276034/ 878681x 100= 31.14% or 31%
Insured Under current law excluding high risk 738645/1655534 x 100= 44.61% or 45%
Insured under ACA excluding high risk 916889/ 1655534 x 100= 55.38% or 55%.
CASE STUDY 5 13

References

CDC. Gov. (2019). The Affordable Care Act Helps People Living with HIV/AIDS. Retrieved

from https://www.cdc.gov/hiv/policies/aca.html

Fleming, S. T. (2008). Managerial Epidemiology: Cases and Concepts (3rd ed., p. 3). Chicago:

Health Administration Press.

Knickman, J., Kovner, A., & Jonas, S. (Eds.). (2015). Jonas and Kovner's health care delivery in

the united states (11th ed.) [11th edition.]. New York, NY: Springer Publishing

Company, LLC. (2015).