Nearly A Quarter Of Health Marketplace Enrollees Are Young Adults
By Phil Galewitz
KHN Staff Writer
Jan 13, 2014 - Kaiser Health News
Nearly a quarter of the 2.2 million people who have enrolled in health
coverage in the health law's insurance marketplaces are young adults — the
population that's hardest to reach and yet most vital for the financial
stability of the new exchanges, the
Obama administration announced Monday.
While federal officials say they are pleased with the early turnout, they
want to increase the proportion of young adults buying plans before open
enrollment ends March 31. Almost 40 percent of the potential market for the
exchanges is people 18 to 34 years old. Based on the Congressional Budget Office
estimate that 7 million people would enroll this year, that would be 2.7 million
young adults.
According
to the government figures released Monday, 24 percent of those
enrolling in the marketplaces through Dec. 28 were adults ages 18 to 34. Though
no one expected young adults to be first in line signing up for coverage this
fall, trouble with healthcare.gov during October and November has increased the
challenge of reaching them.
President Barack Obama met with some of the people helping
with health care enrollment efforts on Friday in Washington. (Photo by Olivier
Douliery-Pool/Getty Images).
"There's no question because of the technological challenge, that outreach to
that population was put on hold and folks coming to the website in October and
November were those who were super-motivated," said Sabrina Corlette, research
professor at the Health Policy Institute at Georgetown University .
Corlette noted that experts always expected most young people to wait until
late in the enrollment period to enroll. "I do not see anything about the age
breakdown figures that strikes me to get super excited about or super depressed
about," she said.
Getting enough young adults to sign up for coverage is critical to keeping
the marketplaces financially viable by subsidizing the older and sicker people
who are gaining coverage because insurers can no longer turn people away for
pre-existing illnesses or charge them higher rates. If too many sick people buy
insurance, it could lead to higher rates in future years that could eventually
compromise the market. The health law's individual mandate was put in
place largely to make sure young adults signed up.
The details about young adults came in a briefing from top Health and Human
Services officials and from an HHS report that for the first time provided
details about enrollees' age and plan choice on a state by state basis. Some
states individually had released data.
The officials announced:
-- About 60 percent of people buying policies on the marketplaces chose a
silver plan, 20 percent bought bronze, 13 percent bought gold and 7 percent
bought platinum. Policies run from platinum as the most expensive, followed by
gold, silver and bronze, the lowest tier. The higher the metal tier, the higher
the monthly premium but the lower the copays and deductibles.
--Only about 1 percent of people chose a catastrophic plan which requires
enrollees to pay much of their medical costs up to a certain amount.
Catastrophic plans are available for people under age 30, those with a financial
hardship or those who have had their insurance policy canceled.
--About 80 percent of those buying a plan qualified for a financial
subsidy.
-- Women were more likely to purchase plans on the exchange with only 46
percent of enrollees being male. Administration officials say they hope to
enroll more men.
--The top five states for enrollment are California (498,794), Florida
(158,030), New York (156,902), Texas (118,532) and North Carolina (107,778).
Young adults are the most likely group to lack coverage — 19 million people
between 18 and 34 are uninsured. Most say they do not buy policies because they
canft afford it, says Aaron Smith, founder and executive director of nonprofit
group Young Invincibles, a proponent of the health law.
"The 24 percent figure suggests we are on the right track," he said. About 18
million of the 19 million will qualify for subsidies to buy private coverage or
for Medicaid, he said.
Because of concerns about sicker consumers overwhelming the risk pool, much
attention has been centered on young adults. But Cori Uccello, senior health
policy fellow at American Academy of Actuaries, cautioned that age distribution
is only important as a rough barometer of health status of people signing
up for coverage. "Itfs not just the distribution of age, but the health status
at every age and what is their experience (in using insurance)," she said.
She added that the age distribution of those buying coverage only matters if
it's much different than what insurers based their assumptions on in setting
premiums.
"Among young adults, momentum is particularly strong," Health and Human
Services Secretary Kathleen Sebelius said in the telephone briefing with
reporters. In addition to young adults buying health plans, about 3
million have gained coverage because of a provision in the law that allow them
to stay under their parents' policy until age 26, she said.
The data about young people released Monday mirror what some state
marketplaces have already reported. There had been concerns that states relying
on the federal exchange would have less consumer outreach and would have a lower
proportion of younger people signing up. So far, therefs not a big difference.
Among the 14 state exchanges, about 25 percent of enrollees are between 18 and
34 compared to 23 percent for the 36 states in the federal exchange.
The percentage of young people enrolling ranges from 17 percent in West
Virginia and Arizona to 44 percent in the District of Columbia. The individual
state proportions matter because each state is a different insurance market that
has its own pricing.
The low level in Arizona is ga little surprising because wefve been doing
enrollment at community colleges and we have had a good response,h said David
Aguirre, health care marketplace coordinator for the Greater Phoenix Urban
League.
But since so many of the students live out of state, they may be reluctant to
enroll in Arizonafs exchange, which is administered by the federal government,
he said. Now that the second semester of college has started for many
students, Aguirre said his staff is giving it another try.
He expects more younger people will enroll by March 31. gWe are pushing every
day and we are out there bugging them to make sure they understand,h he said.
Smith of the Young Invincibles said that the disparity of rates among states
shows those doing outreach will see a larger share of young people sign up.
No data was released about people enrolling in individual plans outside the
marketplaces. Those numbers could, of course, impact insurersf risk pools.
HHS officials said that some of the differences reflect differences in the
average age of state populations. They noted that West Virginia and Arizona have
higher percentages of older people than some other states.
California, which accounts for nearly 500,000 people who have chosen a health
plan, had 25 percent enrollment among young adults.
HHS spokeswoman Julie Bataille said the administration would widen its
outreach efforts in the next few months, which is expected to include television
advertising during the Olympic Games in February.
gThere has been a lot of attention to the mix of individuals signing up for
coverage so at the end of the day we have a balanced insurance pool,h said Mike
Hash, who directs the HHSf Office of Health Reform. gThe trend is suggestive of
an appropriate mix in the marketplace. We are only halfway through and we expect
an increase in the proportion of young adults as we go forward.h
A recent survey by The Commonwealth Fund, a nonpartisan research group, found
that 41 percent of those who had shopped on state marketplaces were ages 19 to
34.
A study in November by the Kaiser Family Foundation (KHN is an
editorially independent program of the foundation), downplayed concerns about so
called "death spiral" if not enough young people enrolled. Under a worst-case
scenario in which just 25 percent of enrollees are age 18 to 34, then insurers
would have to raise premiums by just 2.4 percent in 2015.
Kaiser Health News staff writer Mary Agnes Carey contributed to this
report.
© 2014 Henry J. Kaiser Family Foundation. All rights reserved.