Fears that insurance exchanges that are the linchpin of President Barack Obama’s federal health care overhaul wouldn’t attract the young, healthy people needed to make them financially viable are being heightened by the early results of sign-ups in several states.
If it becomes a trend, that could lead to increases in insurance premiums and deductibles next year. Along with the paltry enrollment numbers released this week, officials in a handful of states said those who had managed to sign up were generally older people with medical problems — those with the greatest incentives to get coverage.
It’s unclear whether that will persist. Young, healthy people may be more inclined to procrastinate, especially given doubts about the law’s technically flawed online signup system. They have until Dec. 15 to sign up if they want to be covered Jan. 1.
Insurers have warned that they need a wide range of people signing up for coverage because premiums paid by adults in the younger and healthier group, between 18 and 35, are needed to offset the cost of carrying older and sicker customers who typically generate far more in medical bills than they contribute in premiums.
The first set of enrollment data revealed that 106,000 people signed up for coverage nationwide, far short of the 500,000 initial sign-ups the Obama administration had expected. In states where officials discussed more detailed information, it also became apparent that the people who flocked to the exchanges after they opened Oct. 1 were those who were desperate for coverage.
In California, the state with the largest uninsured population, most of those who applied were older people with health problems.
In Kentucky, nearly 3 of 4 enrollees were over 35. In Washington state, about 23 percent of enrollees were between 18 and 34. And in Ohio, groups helping with enrollment described many of those coming to them as older residents who lost their jobs and health coverage during the recession.
“They have been putting off treatment for a long time, just praying they live until they turn 65 and qualify for Medicare,” said Lisa Hamler-Fugitt, executive director of the Ohio Association of Foodbanks, which received federal grant money to help people establish coverage.
That people with serious health conditions would be the first to take advantage of the Affordable Care Act was expected. But that direction must shift.
In general, someone in his 60s uses $6 in health care services for every $1 tallied by someone in his 20s, said Nicole Kasabian Evans of the California Association of Health Plans. That makes younger adults a coveted group on industry balance sheets.
If those signing up trend to the elderly and sickly, “your insurance is going to cost more, and that will discourage those younger people from coming in,” warned Lisa Folberg, a vice president with the California Medical Association. Faced with steep prices, younger people could opt to pay a fine rather than purchase coverage.