Young adults make up almost one-quarter of sign-ups in health-insurance exchanges
By: Amy Goldstein and Sandhya Somashkehar (The Washington Post) January 2014
Young adults account for slightly less than one-fourth of the Americans who signed up for health plans during the initial three months of federal and state insurance marketplaces — a smaller share than government and industry officials have said will be pivotal to making the economics of the health-care law work.
The figures, part of a monthly progress report issued Monday on enrollment in the new marketplaces, offer the first glimpse into whether the health plans available under the Affordable Care Act are becoming provinces of the sick and old — or are managing to attract young, healthy people who previously did not consider insurance worthwhile.
According to the report, released by Health and Human Services Secretary Kathleen Sebelius, 23 percent of nearly 1.2 million people who enrolled through the federal insurance marketplace by the end of December are between the ages of 18 and 34. In 14 states and the District, which are running their own new marketplaces, 25 percent of the nearly 900,000 people who enrolled fall within that age group.
The figures mean that the proportion of young adults who have signed up is smaller than estimates by the government and outside health policy analysts have suggested is necessary to make the exchanges work well. It is estimated that roughly two Americans in five in the new health plans should be young adults to prevent the plans’ premiums from rising and some insurers from potentially dropping out.
In releasing the report, several federal health officials gave an upbeat portrayal, saying that they were pleased with the progress and predicting that the plans will attract more young adults during the second half of an open enrollment period that continues through March. The report “is solid, solid news for us,” a senior Obama administration official told reporters at a White House briefing.
The numbers, however, ratchet up the pressure on outreach efforts around the country to persuade young people to sign up. Their willingness to do so — even in the face of a new legal requirement that most Americans have coverage–has hovered as one of the uncertainties about how the law would work in practice.
The proportion of young people — 24 percent overall — “is lower than would be ideal,” said Larry Levitt, senior vice president at the Kaiser Family Foundation, which completed a study last month showing that 40 percent of the U.S. population that could benefit from the new insurance marketplaces are 18 to 34 years old. But Levitt called the proportion “an encouraging number,” given that 2 1/2 months remain for people to enroll for coverage this year and that the federal online system, HealthCare.gov had defects that prevented many people from signing up for much of the fall.
Robert Zirkelbach, spokesman for America’s Health Insurance Plans, the industry’s main trade group, said the impact of who buys coverage “is more a continuum than a cliff” and pointed out that insurance prices are influenced by both the age of customers and how much health care they need. “The more young, healthy people participating, the more stable the marketplace will be, and the more affordable coverage will be.”
Beyond the age breakdowns, the report issued Monday also contains the first information on the gender of people buying new health plans and which of several tiers of insurance are proving the most popular.
Fifty-three percent of the people who have chosen health plans are women, and 47 percent are men, with a slightly higher percentage of women in the federal marketplace than in the state exchanges.
The report also shows that, of four levels of coverage, named for different metals, by far the most popular is the “silver” tier plans — the second level from the bottom and the one that serves as the basis for the size of federal subsidies.
Under the law, the government is for the first time providing subsidies to help Americans pay for private health insurance. The report says that, during the first three months of enrollment, about four in five people who signed up qualified for a federal tax credit — 80 percent in the federal marketplace and 78 percent, on average, in the separate state marketplaces.
The overall enrollment figures in Monday’s report echo information the White House already has issued, showing a substantial upswing in consumers choosing health plans in December as problems with HealthCare.gov that had daunted many people trying to shop for health plans tapered off. In contrast to the first two enrollment reports, covering October and November, the enrollment from the three dozen states relying on the federal exchange now exceeds that from the states with their own marketplaces.
The enrollment in the federal marketplace increased seven-fold in December, while it tripled, on average, in the state ones.
While Americans can sign up through March 31 for coverage in 2014, the December enrollment period was especially significant because the health plans took effect on New Year’s day and anyone who signed up by Dec. 24 — and pays the first months’ premium by various deadlines this month — is covered from the beginning. Under the health-care law, most people will risk a financial penalty if they have not chosen coverage by the end of March.
