My must read of the day "Enrollment in the Health Insurance Marketplace totals over 8 million people," by the Health and Human Services Press Office:
Enrollment in the Health Insurance Marketplace surged to eight million at the end of the first enrollment period, HHS Secretary Kathleen Sebelius announced today. The final enrollment reporting period spans from October 1, 2013, to March 31, 2014, and includes "in line" and other enrollment activity (such as people enrolling due to a change in life circumstance) reported through Saturday, April 19, 2014.
Importantly, 2.2 million (28 percent) of those who selected a Marketplace plan were young adults ages 18 to 34 — a number that grows to 2.7 million when counting ages 0 to 34, the report found. The report also shows, for the first time, the race and ethnicity of the 69 percent of enrollees in the Federally-facilitated Marketplaces who voluntarily reported this information.
Setting aside the questions that some have when it comes to the 8 million figure, this (final) enrollment report shows that the administration has not met its prediction in the most important category: young invincibles.
The percentage is higher than the 25 percent it previously hovered at, but it’s still far short of predictions. Supporters maintained that young people would sign up towards the end of enrollment, because they didn’t have an immediate need for insurance. According to the report, "the cumulative number of young adults selecting a marketplace plan has doubled—increasing by 109 percent," in the last month—but that still doesn’t mean enough signed up.
What’s always important with this percentage is the state-by-state breakdown. The young people in one state will only pay for the older people in their state—that means the overall breakdown isn’t very helpful.
The White House and CBO originally said 40 percent of enrollees needed to be between the ages of 18 and 34 in order to ensure that the risk pool was balanced. If that number isn’t reached, premiums could go up.
The only place that reached that number is District Columbia at 45 percent (though many would contend that number is skewed since congressional staffers were forced into the District’s exchange). Utah came in second with 31 percent of enrollees between the ages of 18-34. West Virginia has the lowest percentage at 19.
Those are not great numbers, and, since the ACA prevents insurers from setting premiums based on health status, the age breakdown is critical. Insurers can charge different premiums based on age groups, and young people have to pay for more than the services they typically use in order to pay for the older group, where sicker enrollees tend to be.
The administration has not reached the 40 percent they predicted anywhere, except D.C.—the percentages might not be low enough to cause a "death spiral," but it’s still a problem that may lead to an increase in premiums.