Health Care Plans Attracting More Older, Less Healthy People

WASHINGTON — People signing up for health insurance through the Affordable Care Act’s federal and state marketplaces tend to be older and potentially less healthy, officials said Monday, a demographic mix that could cause premiums to rise in the future if the pattern persists.

But officials expressed optimism that more young people will sign up in the months ahead, calling it “solid, solid news” for the health care law. They said demand for insurance through the marketplaces was increasing sharply across all age groups and they said youth outreach will become more aggressive in the months ahead.

“We’re pleased to see such a strong response and heavy demand,” said Kathleen Sebelius, the secretary of health and human services. “Among young adults, the momentum was particularly strong.”

Officials for the first time released basic demographic information about the people signing up for insurance. Of those who signed up in the first three months, 55 percent are age 45 to 64, officials said. Only 24 percent of those choosing a health insurance plan are 18 to 34, a group that is usually healthier and needs fewer costly medical services. People 55 to 64 – just below the age at which people qualify for Medicare -- represented the largest group, at 33 percent.

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Over all, officials said that 2.2 million people had signed up by Dec. 28 for health insurance through HealthCare.gov and the state-based websites. Administration officials have previously said they hope to see seven million people enrolled in private health plans through the federal and state exchanges by March 31.

Of those who signed up, about 54 percent are women and 46 percent are men. Nearly 80 percent of those who selected a plan qualified for federal subsidies to reduce their premiums, officials said.

Federal officials do not know how many of the people selecting plans were previously uninsured, how many were African-American or Hispanic, or how many have paid premiums. Consumers are required to pay their share before coverage takes effect.

The age breakdown was the most highly anticipated data being released because of what it could say about the health of those who will be insured. Under the law, insurers can no longer deny coverage or charge higher premiums because of a person’s medical history or pre-existing conditions. As a result, White House and health policy experts have repeatedly said that insurers need to sign up large numbers of younger people to balance the financial risks of covering older Americans who require more medical care.

Officials on Monday said they were basically pleased with the percentage of young people and said it was consistent with their expectations and with the experience in Massachusetts, which put in place a similar kind of public health insurance exchange.

“We think that more and more young people are going to sign up as time goes by,” said Gary Cohen, the director of the Center for Consumer Information and Insurance Oversight at the Centers for Medicare and Medicaid Services.

Republicans quickly jumped on the information as evidence that the administration was still short of its goals for the health care program. Brendan Buck, a spokesman for Speaker John A. Boehner, predicted that insurance premiums will rise.

“There’s no way to spin it: youth enrollment has been a bust so far,” Mr. Buck said. “When they see that Obamacare offers high costs for limited access to doctors – if the enrollment goes through at all – it’s no surprise that young people aren’t rushing to sign up.”

Larry Levitt, a senior vice president of the Kaiser Family Foundation, has said that “the mix of enrollment is much more important than the total number.”

“If you assume that sicker individuals are likely to come in first, then a smaller pool is likely to be a sicker pool,” Mr. Levitt said. “The best guarantee of a diverse pool is a big pool, because that means you are probably reaching younger and healthier people.”

Mr. Levitt said that people enrolling early included some with the greatest needs: people who had been locked out of the individual insurance market because of serious illnesses and those coming from federal and state programs for people with pre-existing conditions.

Robert E. Zirkelbach, a spokesman for America’s Health Insurance Plans, a trade group, said “it’s too early to know” if the enrollment of younger and healthier people was adequate to keep premiums stable in coming years. Insurers will need to see enrollment numbers for the full six-month period, he said.

Many people who bought insurance on their own have received notices saying their policies were being canceled or discontinued because the policies did not comply with coverage requirements of the new health care law. Those expecting high medical bills had the strongest motivation to overcome the obstacles to buying insurance on the federal exchange.

Mike Hash, the director of the Office of Health Reform at the Health and Human Services Department, said that premiums will be determined in part by the demographic mix of those insured in each state. He said that the current trends “are suggestive of an appropriate mix” by the end of the enrollment period.

“We need to continue and accelerate our outreach efforts. That’s what we are doing,” Mr. Hash said. “We are confident based on the results we have now that we will have an appropriate mix of people.”

In December, for the first time, the number of people selecting plans in the federal exchange exceeded the number signing up through state exchanges.

For the first half of the enrollment period, through December, the federal exchange, which serves 36 states with about two-thirds of the nation’s population, accounted for 56 percent of all the people selecting plans. The other 44 percent signed up in state exchanges.