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Reform Update: HHS will boost efforts to encourage young adults to enroll in exchanges


By Virgil Dickson
Posted: January 13, 2014 - 4:30 pm ET
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About one-fourth of Americans who have signed up for health coverage through the federal and state insurance exchanges so far are between the ages of 18 and 34, indicating that the Obama administration, the states and insurers have their work cut out to get more younger and healthier people to sign up before open enrollment ends March 31.

HHS officials released exchange enrollment totals Monday along with their first demographic breakdown of enrollment in the 36 states served by the federal exchange and the 14 states plus the District of Columbia served by state-run exchanges. They said 24% of enrollees are 18-34. In addition, 54% are female and 46% male. The 24% figure is below the approximately one-third share of younger people that some experts say exchanges need to keep costs affordable and prevent a significant premium increase on the exchanges in 2015.

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In addition, HHS for the first time revealed the percentage of enrollees who qualify for federal premium subsidies as well as the percentages that chose bronze, silver, gold, platinum and catastrophic plans. Overall, 79% of enrollees qualified by income for a premium tax credit, which is higher than expected. Twenty percent chose bronze plans, 60% silver, 13% gold, 7% platinum and 1% catastrophic. Experts say silver plans rather than bronze plans are a better choice for many lower-income people because the cost-sharing is lower and enrollees earning less than 250% of poverty who sign up for silver plans qualify for federal cost-sharing subsidies.

“The one thing that is significant is that people aren't just signing up for the bronze plans because they are cheap,” said Tim Jost, a Washington & Lee University law professor who has closely followed the Obamacare implementation and who listened in on HHS' call with reporters. “Most are signing up for the silver plans because they can get a cost-sharing reduction.”

More than three months after open enrollment began on the exchanges, just under 2.2 million people have selected private insurance plans as of the end of December, close to what HHS reported last month. Another 1.6 million people have been found eligible for Medicaid or the Children's Health Insurance Program through the exchanges. The Medicaid enrollment total does not include people who signed up through state Medicaid agencies, HHS officials said Monday.

Most of those who enrolled in private plans—roughly 1.8 million—signed up in December. That means seven times as many people enrolled in December as in October and November, demonstrating that the administration's repair of the HealthCare.gov website was relatively successful.

“Our outreach efforts have ramped up, so whether it's through public service announcements, events, our champions or other means, we are doing all we can to find, inform and enroll those who can benefit from the marketplace, HHS Secretary Kathleen Sebelius said on the call Monday with reporters.

Moving forward, HHS plans to increase efforts to encourage young adults to enroll in exchange plans as they are in the age group that's most likely to be uninsured.

HHS officials said they were not surprised by the finding that only 24% of those who signed up are 18-34, since older and sicker people were expected to be more eager to sign up in the initial enrollment period. Experts had predicted that younger and healthier people without immediate healthcare needs would procrastinate.

Despite the slower pace of younger people signing up, the agency “is pleased” with the mix of beneficiaries so far, CMS spokeswoman Julie Bataille said.

The administration had been concerned that the pool would be overloaded with too many unhealthy people, which would have meant rates for exchange plans may have gone up significantly in 2015. Those concerns, shared by insurers, increased when the Obama administration announced that people could keep their existing health plans that were not compliant with Patient Protection and Affordable Care Act coverage requirements.

During the Monday call, HHS officials were unable to provide information about the racial or ethnic demographics of enrollees, the breakdown of people who had not previously been on Medicaid, or how many had actually paid their premium, which is required for actually obtaining coverage.

Many plans have announced they have extended deadlines for people to pay the premiums until the end of January for coverage that's effective Jan. 1.

A recent Kaiser Family Foundation study found that consequences of lower-than-hoped-for enrollment among young adults wouldn't be as dire as some say because insurers still can charge older enrollees higher premiums, limited by an age rate band of 3-1.

The CBO estimated that 7 million people would sign up for coverage through the exchanges by March 31. It had said that 40% of them, or 2.8 million, would need to be younger adults to subsidize the costs of older adults.

But Kaiser projected that even if young adults ages 18-34 enroll at a 25% lower rate than other individuals eligible for exchange coverage, that would lead to only 1.1% higher premiums in 2015.

Commenting on the percentage of younger people who have signed up so far, Jost said the Obamacare exchanges are drawing a higher initial percentage of younger enrollees than the Massachusetts exchange did in 2006. “I think it's fine,” he said.

Follow Virgil Dickson on Twitter: @MHvdickson


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