Obamacare triggering upturn in preventative care — and risky drinking, too

Russian River Brewing Co. customers clink beer glasses before drinking Pliny the Younger triple IPA.

Obamacare is delivering an increase in preventative-care utilization — but also an upturn in risky drinking.

That’s the finding of a new working paper published by the National Bureau of Economic Research, from researchers at Georgia State University, the University of Pennsylvania, the University of Kentucky and Impaq International.

They used what’s called the Behavioral Risk Factor Surveillance System, a massive study conducted each year between 2011 and 2016 by the Centers for Disease Control and Prevention.

The good and not really surprising news is that health insurance, by lowering the portion of medical costs borne by a patient, has triggered an upturn in the use of preventative care and related medications and counseling services.

Between 17% and 50% of newly insured individuals increased their preventive-care usage, such as scheduling healthy-patient doctor visits and seeking flu shots, the researchers found. The effects are particularly pronounced for those with below-median incomes.

The downside is there is a 1.6-percentage-point increase in the probability of being a risky drinker, defined as 60 drinks per month for men and 32 drinks for women, or any episodes of binge drinking.

Higher-than-median incomes more broadly have been engaged in worse behavior, not just drinking more but smoking more as well.

The researchers posit that moral hazard is at play — if things get bad, people have decided others will pay the cost.

Another interesting development is the finding that the package of national reforms including regulations in the non-group insurance market, mandates and subsidized health insurance exchanges are drivers of these behavior changes.

The Medicaid expansion by some states hasn’t, which could be because Medicaid historically pays providers much less than private insurers do, the researchers found. But the researchers also pointed out that Medicaid increased its payment rates to match those of Medicare in 2013 and 2014.

The working paper has not been peer reviewed.

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