Where are the young? Older, costlier Americans signing up for insurance under health care law

By Ricardo Alonso-zaldivar

Associated Press

Published: Monday, Jan. 13 2014 3:26 p.m. MST

In this Dec. 11, 2013 file photo, Rosemary Cabelo uses a computer at a public library to access the Affordable Health Care Act website, in San Antonio. The Obama administration says following a December surge, more than 1.1 million people have now enrolled for health insurance through the federal government’s improved website.

Eric Gay, Associated Press

WASHINGTON — It's an older, costlier crowd that's signing up so far for health insurance under President Barack Obama's law, according to government figures released Monday. Enrollments are lower for the healthy, younger Americans who will be needed to keep premiums from rising.

Young adults from 18 to 34 are only 24 percent of total enrollment so far, the administration said in its first signup figures broken down for age, gender and other details. With the healthcare.gov website now working, the figures cover the more than 2 million Americans who had signed up for government-subsidized private insurance through the end of December in new federal and state markets.

Enrolling young and healthy people is important because they generally pay more into the system than they take out, subsidizing older adults. While 24 percent is not a bad start, say independent experts, it should be closer to 40 percent to help keep premiums down.

Adults ages 55-64 were the most heavily represented in the signups, accounting for 33 percent of the total. Overall, the premiums paid by people in that demographic don't fully cover their medical expenses. Some are in the waiting room for Medicare; that coverage starts at age 65.

Some questions remained unanswered.

For example, the administration is unable to say how of many of those enrolling for coverage had been previously uninsured. Experts believe many of the early signups were people who had their own coverage. Some might have been among the more than 4.7 million whose previous policies were canceled because they didn't meet the law's standards.

"The uninsured folks for whom the law was intended don't seem to have signed up in nearly as high numbers," said Richard Foster, who previously served as the HHS statistics chief. "There is still a huge unknown aspect to this."

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. Premiums would go up next year for the overhaul, 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, "it underscores a need to heighten outreach efforts to young people," added Levitt. Adults ages 18-34 represent 40 percent of the target group for the health care law, according to a recent Kaiser study. Open enrollment ends March 31.

Considering that the federal health care website was down most of the time in October, administration officials said they were pleased that the percentage of young adults was as high as it was.

"We think that more and more young people are going to sign up as time goes by," said Gary Cohen, head of the Health and Human Services Department's office in charge of Obama's push to cover the uninsured.

With Monday's numbers, a fuller picture has started to emerge of who's signing up. But there are still gaps.

Some of the highlights:

— The administration continues to play catch-up. Originally, officials hoped to sign up more than 3.3 million people through the end of 2013, nearly halfway to the goal of 7 million enrollments by the end of March. Instead, enrollment as of Dec. 31 was not quite 2.2 million.

— Fifty-four percent of those who signed up were women, a slightly higher proportion of females than in the population.

— Nearly four out of five who signed up got financial help with their premiums.

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