My attention to Massachusetts’ individual mandate and the extent of “gaming”* thereof raises another issue, one on which I haven’t yet explicitly focused. The reason we do not know how much gaming of the Massachusetts mandate occurs or the implications of it for premiums is that the relevant data aren’t available to researchers. I know this from two e-mails from academics who study Massachusetts health reform (one of which I quoted earlier).
The paucity of data from private health insurance plans participating in public programs is not new. The Medicare Advantage program also obscures a substantial amount of health care utilization data for private plan enrollees that is otherwise available for traditional Medicare users. I know well the limitations this imposes on research, including my own.
There is a consequence to proprietary barriers to data access. We don’t learn as much and, thus, we don’t know as well what works or doesn’t. What we end up knowing is driven to a larger extent by industry statements and reports than it is by less biased scholarly analysis. This is a real loss and has implications for policy and government budgets.
As just one example, the one I’ve been writing about, will the Affordable Care Act’s individual mandate penalties be sufficient to discourage gaming and limit the adverse selection associated with it? Much of the evidence from Massachusetts and my own analysis suggests they will be. But recent industry reports of gaming give us pause. If only we researchers had the data to judge for ourselves we might be able to draw more solid conclusions.
In a few years, when national health reform is implemented questions such as this will be raised on a national scale. Will we have the data to answer them? Or will we be at the mercy of the industry (again)? This is a tree-falls-in-the-woods question. If we can’t measure the effect of health reform, what happened? Anything good? Well, it is a large tree and we will have paid for it! Wouldn’t you like to know what you’re getting for the money? Me too.
* Some object to the use of this term. I use it here as a convenient shorthand for short-term insurance purchase timed to coincide with increased risk of high health expenses and the payment of the low penalty otherwise.