The Obama administration today revealed that more than half of the sign-ups for ObamaCare are aged 45 and older, hardly the sort of young, healthy insurance pool the White House was hoping for.
On their websites, the Wall Street Journal, USA Today, and New York Times all focused on the older/sicker skew of the Healthcare.gov signups. The Washington Post, however, tried to accentuate the positive for the administration. "Young adults make up almost one-quarter of health sign-ups," cheered the WashingtonPost.com headline [see collage of headlines below the page break]. But as Louise Radnofsky reported for the Journal (emphasis mine):
More than half of those signing up for private health plans on new insurance exchanges are 45 or older, the Obama administration said Monday, a sign that the rough rollout of the exchanges may have skewed early enrollment.
In all, nearly 2.2 million people across the country signed up for individual coverage through Dec. 28, with a significant uptick in December after anemic numbers in October and November as consumers battled through technical problems.
With the worst of those problems largely resolved at the federal HealthCare.gov website, attention is now shifting to the demographics of the new enrollees, which is likely to determine the long-term impact of the law.
At the heart of the health overhaul law is a change in the way insurance is priced. Consumers no longer pay premiums based on their health risks, and health plans are limited in how much they can vary prices based on age. To keep prices in check in the new market, carriers say they need strong enrollment from younger people who are likely to be healthier, to balance out the bills that could be racked up by sicker and older people. If that doesn't happen, prices will likely spike sharply in subsequent years, actuaries say.
Across the country, some 33% of the nearly 2.2 million people who signed up were between the ages of 55 and 64, and an additional 22% were between 45 and 54, according to nationwide data compiled by the Department of Health and Human Services. The federal government is running insurance exchanges on behalf of 36 states, while 14 states and the District of Columbia are operating their own exchanges.
As Robert Pear and Michael Shear noted in their January 13 story for the Times:
Larry Levitt, a senior vice president of the Kaiser Family Foundation, has said that “the mix of enrollment is much more important than the total number.”
“If you assume that sicker individuals are likely to come in first, then a smaller pool is likely to be a sicker pool,” Mr. Levitt said. “The best guarantee of a diverse pool is a big pool, because that means you are probably reaching younger and healthier people.”
Mr. Levitt said that people enrolling early included some with the greatest needs: people who had been locked out of the individual insurance market because of serious illnesses and those coming from federal and state programs for people with pre-existing conditions.
But for their part, in their story "Young adults make up almost one-quarter of sign-ups in health-insurance exchanges," Post scribes Amy Goldstein and Sandhya Somashekhar tried to accentuate the positive as well as to chalk up the lack of youth registrants to website problems, not the fact that for most young people it makes little sense to buy coverage as opposed to stay on a parent's plan or just deal with a fine extracted from their income tax refund (emphasis mine):
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.
