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Younger, healthier enrollees missing in Affordable Care Act

| Monday, Jan. 13, 2014, 11:48 p.m.
Federal officials for the first time provided demographic data on enrollees, confirming concerns that fewer young and healthy Americans than hoped for have sought coverage under President Obama’s signature legislative achievement, the Affordable Care Act.

About two in five Pennsylvanians who signed up for health insurance under the Affordable Care Act in the past three months were 55 or older, the government said on Monday.

Federal officials for the first time provided demographic data on enrollees, confirming concerns that fewer young and healthy Americans than hoped for have sought coverage under President Obama's signature legislative achievement.

If not enough young Americans buy coverage to offset the cost of insuring older and more sickly people, premiums will rise.

Only 24 percent of enrollees in Pennsylvania were ages 18 to 34, according to the government's report covering sign-ups on from Oct. 1 to Dec. 28. That mirrors the percentage nationally. Insurance shoppers in Pennsylvania and 35 other states use the federal website; 14 states set up their own websites.

Experts have said 40 percent of enrollees between the ages of 18 and 34 would be ideal to prevent rates from rising.

Obama administration officials declined to specify a target percentage for enrollment of young people but said they were pleased with sign-ups and expect more to buy coverage before open enrollment ends on March 31. They noted that 26 percent of the younger-than-65 population in America is between 18 and 34.

“The trends are suggestive of an appropriate mix,” Michael Hash, director of the Office of Health Reform at the Department of Health and Human Services, told reporters on a conference call. “We expect an increase in the proportion of young adults as we go forward.”

Even if the age mix remains tilted toward older adults, “it's nothing of the sort that would trigger instability in the system,” said Larry Levitt, an insurance expert with the nonpartisan Kaiser Family Foundation in Menlo Park, Calif. Premiums would go up next year, along with taxpayer costs per enrollee, but not enough to push the system into a “death spiral” in which rising premiums discourage healthy people from signing up.

Still, the higher number of older people in the risk pool “underscores a need to heighten outreach efforts to young people,” Levitt said.

Highmark Inc., Pennsylvania's largest health insurer, declined to provide an age breakdown but said its membership “is in line with federal marketplace numbers, which shows that there are more older purchasers than younger purchasers.”

“These demographics are what we anticipated but are of concern because having balanced membership is fundamental to insurance,” the company said in a statement.

The government's report shows that 60 percent of enrollees nationwide selected silver level plans, which analysts expected to be the most popular. The are four categories of plans sold on and state exchanges, varying by the percentage of medical costs covered. Silver plans cover 70 percent of costs.

Fifty-four percent of enrollees are female. Seventy-four percent qualify for tax credits to offset some of the cost of monthly premiums.

Despite a bungled rollout of — in which technical problems prevented many from signing up during the first two months — enrollments shot up in the region, state and across the country last month.

When the government announced on Dec. 1 that the website worked smoothly for most users, nearly 1.8 million Americans selected health plans, compared with 258,500 in November. As of Dec. 28, 2.15 million Americans were signed up.

The same surge was reported in Pennsylvania, as 69,500 people selected plans in December, bringing the three-month total to 81,320.

And in Western Pennsylvania, Highmark gained 27,000 enrollees between Dec. 9 and Jan. 13, more than three times the members it signed between Nov. 12 and Dec. 9. Its total enrollment through Jan. 13 was 37,132.

Deborah Rice-Johnson, president of Highmark Health Services, said in a statement that ongoing changes by the government made enrollment rocky.

“Despite the challenges, Highmark remains committed to making affordable health care coverage available through the federal marketplace, and we are pleased to see that so many individuals chose Highmark as their health insurance provider,” she said.

Alex Nixon is a Trib Total Media staff writer. The Associated Press contributed.

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