A relatively new Medicaid expansion program in Indiana is now offering experience data that is meaningful in the context of healthcare reform. The first year of this voluntary program revealed certain behavior by uninsured populations as they acquired coverage. Utilization levels for these populations were higher than average, and in many cases early adopters were also among the sickest and most costly, with healthier and less costly individuals joining later. The year of experience reveals various aspects of antiselection and pent-up demand.

These results offer lessons for nationwide attempts to cover the uninsured, especially for any attempts that pursue such ends on a voluntary basis. Voluntary programs for covering the uninsured may exhibit similar results. These results have important cost implications.