Young adult enrollment in health care marketplaces lags

McClatchy Washington BureauJanuary 13, 2014 


Callers make educational calls regarding the Affordable Care Act in San Jose, Calif., Oct. 23, 2013.

NHAT V. MEYER — Bay Area News Group/MCT

— Halfway through the six-month enrollment period for private marketplace health insurance, just one in four new adult enrollees are between ages 18 and 34, the crucial demographic group whose participation rates are key to keeping monthly premiums affordable under Obamacare.

In the first release of extensive demographic data about the new enrollee population, the Obama administration said Monday that 55 percent, or roughly 1.2 million of the nearly 2.2 million people who’ve selected a federal or state marketplace plan, are generally older adults, ranging in age from 45 to 64.

About 517,000, or 24 percent, of the new enrollees were young adults ages 18 to 34.

The administration also reported Monday that women make up 54 percent of new state and federal marketplace enrollees, 60 percent of enrollees have selected a “silver” plan that covers at least 70 percent of medical expenses, and nearly eight in 10 new plan members qualify for tax credits or other federal subsidies to help pay for their coverage.

The early influx of older enrollees comes as no surprise to most experts who predicted the Affordable Care Act’s new consumer protections and beefed-up coverage requirements would initially attract older people who may have been denied coverage in the past or been unable to purchase affordable health insurance because of pre-existing health problems.

The health law outlaws coverage denials and guarantees access to individual and small-group coverage regardless of current or past health problems.

But in order to keep premiums for marketplace coverage in check, the Obama administration needs roughly 40 percent of new exchange enrollees to be under age 35. This group of younger, typically healthy plan members is cheaper to insure and would offset the coverage costs for older plan members who are generally sicker and more costly to cover.

Dan Mendelson, CEO of Avalere Health, a health care consulting firm, said the early rush of older plan members isn’t a problem – yet.

“I look at this and say it’s a modestly negative sign, but it is not an indication of failure by any means at this point,” Mendelson said. “It’s older than what you want to see from an underwriting perspective, but if the younger population accelerates their enrollment between now and March 31, there won’t be a major problem.”

Administration officials said they were pleased with the mix of young people who’ve signed up thus far, saying the 24 percent share among 18- to 34-year-olds is comparable to their 26 percent share of the general public.

“We are confident, based on the results we have now, that we will have an appropriate mix of individuals enrolled in coverage,” Michael Hash, director of the office of health reform at the U.S. Department of Health and Human Services, said during a conference call with the media.

Aaron Smith, executive director of Young Invincibles, a national advocacy group for young adults, said he expected youth enrollment to increase in the coming months and was “encouraged to see young people enrolling at such a fast clip this early on in the enrollment process.”

Mendelson agreed. “In our enrollment models, the younger people sign up at the end of March because they are more likely to procrastinate,” he said. “That’s how we have been thinking about this all along, so it’s roughly consistent with what we expected.”

Administration officials pushed back on reports that its Spanish-language website, which launched more than two months late, is written in “Spanglish” that some do not understand.

According to published reports, the site,, is clunky and full of grammatical mistakes, and efforts to enroll Spanish speakers in states with large Hispanic populations have fallen short.

A senior administration official said a computer, not a person, translated the English into Spanish, but that someone is going through the translation to fix mistakes if needed.

But the official said many Spanish-speaking people are using the main website, not the Spanish-language one.

The Obama administration will work with college fraternities and sororities and other grassroots groups to focus their enrollment efforts on 25 cities that have the largest numbers of uninsured. Those cities include: Miami, Dallas, Houston, Detroit, St. Louis, New Orleans, Atlanta, Charlotte, N.C., and Austin and McAllen, Texas.

Email:; Twitter: @TonyPughDC

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