For instance, some observers have compared the health reform rollout with the launch of the Medicare prescription drug benefit in 2006. But the two initiatives differ in many important ways, said Dr. Mark McClellan, who led the CMS during that initiative. A primary one is the target population of each.
“A lot of the stability of these markets depends on the participation of the young and healthy,” McClellan said in an interview.
The importance of enrolling healthy adults who do not use many healthcare services was a critical point emphasized by the administration in its outreach announcements.
“We're hopeful that 7 million is a realistic target and that we're going to be driving our efforts toward that kind of enrollment effort,” HHS Kathleen Sebelius said last week, referring to the CBO's earlier estimate of the number of people who would get coverage in the exchanges in their the first year. “And it's both about numbers and also hopefully getting a balanced risk pool,” she continued. “So a lot of our efforts will be using creative ways to outreach to the young, healthy population who is eligible but may not get up every morning thinking about health insurance.”
Young healthy adults, also known as “invincibles,” make up a disproportionately large share of the uninsured. A 2012 PricewaterhouseCoopers analysis of federal healthcare databases concluded that the roughly 30 million uninsured expected to be eligible for new coverage under the law are “relatively young, single and in good shape.”
Health insurance analysts have cited the enrollment of this population, with its low healthcare utilization and costs, as a key both to maintaining the financial integrity of exchange plans and to keeping their costs from spiraling. The Obama administration has echoed this priority with plans to include 2.7 million young adults among the 7 million it plans to enroll in the health insurance exchanges in 2014.
Sebelius said the administration plans to enlist the help of the nation's moms to nudge those young adults into buying health plans.
“Young, healthy males are often referenced as being able to subsidize the older and less healthy,” said Anne Hance, a partner at the law firm McDermott Will & Emery. But, she added, “Does a young healthy male who views himself as invincible want to purchase health insurance coverage if he does the math and sees the penalty is less than what it would be to buy coverage?”
Penalties for lacking qualifying insurance coverage will rise in subsequent years but in 2014 they start at $95 for each adult. In 2014, the penalty will be no more than $285 per family, or 1% of income, whichever is greater, according to the Kaiser Family Foundation. McClellan pointed out that the penalty for Medicare beneficiaries who did not enroll in Part D as soon as they became eligible was relatively higher—a percentage of the “national base beneficiary premium” multiplied by the number of months they went without qualifying coverage is added to all future monthly premiums.
Another critical difference from previous healthcare enrollment drives, such as Medicaid, is that the campaign might need to address a sharp rise in costs for young invincibles.