By the numbers:
3 million — The number of people who have enrolled in private health plans through federal or state health care marketplaces.
6 million — The number of people deemed eligible for Medicaid, the health insurance program for the poor, through the health care marketplaces.
46 percent — The share of male marketplace enrollees.
54 percent — The share of female marketplace enrollees.
24 percent — The share of marketplace enrollees between ages of 18 and 34.
30 percent — The share of marketplace enrollees between the ages of 0 and 34.
Source: U.S. Department of Health and Human Services.
The Obama administration’s decision to let people keep their old health insurance policies is expected to drive down enrollment in state and federal health insurance marketplaces, but that may ultimately benefit insurers selling private plans under the Affordable Care Act.
The Congressional Budget Office last week lowered its estimate for total marketplace enrollment this year from 7 million to 6 million, largely because of President Barack Obama’s decision last November to allow insurers to extend existing policies for at least another year.
That will reduce the number of individuals shifting from their old coverages to the marketplaces, which could mean some insurers will collect premiums from fewer new members than they had anticipated.
But the millions of individuals expected to retain their existing policies will also help cut the health insurers’ risk of paying out more in medical costs than they collect in premiums by keeping some of the costliest people to insure on the sidelines, according to John Bowblis, a health economist at Miami University.
“The people keeping their health plans were likely to be sicker and older to begin with, and the fewer sick people you have enrolling in the marketplace the fewer young, healthy people you need to offset the cost of treating them,” said Bowblis, who noted that prior to the ACA, individual market insurers generally charged higher-than-average rates because of the age and adverse health conditions of many policyholders.
While limiting the participation of high-risk individuals can be good for the marketplaces, a high percentage of younger, healthier enrollees will still be needed to offset the risk that does exist.
The Kaiser Family Foundation has estimated that about 40 percent of those who enroll in marketplace plans need to be young and healthy to mitigate the medical costs of older, sicker enrollees.
By the end of 2013, only about a quarter of the 3 million people who had signed up for marketplace plans nationwide were between the ages of 18 and 34. In Ohio, the share of young, healthy enrollees was even lower: just 19 percent of the 39,955 Ohioans who had selected marketplace plans by Dec. 28, according to government figures.
“Until recently, few advertising dollars have been spent on educating young people about the Affordable Care Act,” said Dave Hickman, director of the Helping Hands Community Outreach Center’s ComCare program, which was established to help local residents navigate Ohio’s health marketplace and facilitate enrollment. “Young people just don’t know what’s out there for them in terms of affordable health care.”
That’s beginning to change as the government has stepped up its outreach efforts to young people since the beginning of the year with television ads featuring celebrity athletes and entertainers touting the benefits of the health care law.
Meanwhile, insurers are beginning to report increased marketplace participation among young people.
Officials at Dayton-based CareSource, a Medicaid managed care provider that also sells marketplace health coverage under the CareSource Just4Me brand, said recently that they were pleasantly surprised by the demographic mix of the more than 12,000 customers who had signed up for coverage by the end of last month.
“From an age standpoint, we are getting a higher percentage of the younger population than we anticipated, which would be a potential indicator that we’re getting a good mix,” said Steve Ringel, president of the company’s Ohio market.
Last week, the top executive at Louisville-based Humana Inc. told investors that about 35 percent of the people who had enrolled in its marketplace plans by the end of January were between ages of 21 and 40.
“While still early, as we analyze the demographics of our (marketplace) membership, we are seeing enrollees skewing a bit more to the younger side,” Humana CEO Bruce Broussard said in a conference call about the company’s fourth-quarter earnings.
While the total number of young people who signed up for marketplace coverage in January won’t be known until the U.S. Department of Health and Human services releases updated numbers later this month, government officials are expecting a crush of new marketplace applicants as the final deadline for enrollment on March 31 approaches.
The White House points to enrollment in Massachusetts’ health-insurance exchange in 2007, when the number of young people signing up for coverage doubled in the final month of open enrollment.
But even if the federal marketplaces follow the same pattern, it is too early to jump to conclusions, said Kev Coleman, head of research and data for HealthPocket.com, a website that analyzes health plans and costs.
“I expect enrollment for January to dip a little and then start to pick up again closer to the deadline,” Coleman said. “Those who can wait until closer to the deadline are likely to be younger, but that doesn’t necessarily mean they’re healthy.”
Because the health care law essentially eliminated the practice of basing insurance premiums on health conditions, otherwise known as medical underwriting, it’s nearly impossible to calculate the health risk of marketplace enrollees, regardless of age, Coleman said.
“At the end of the day, what is more important than age is health because as we know the biggest cost driver for health insurance is medical usage,” he said. “Right now, what we’re trying to do is make inferences based on age. But we really won’t know what that usage is until the claims start to come in, and it will take the entirety of 2014 to determine how medical claims are changing within the health insurance market.”
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