ACA Exchange Enrollment Among Young Adults Lower-Than-Expected

Slightly less than one-fourth of all U.S. residents who enrolled in coverage through the federal and state insurance exchanges between October and December 2013 were young adults ages 18 to 34, according to the latest enrollment data released Monday by HHS, the New York Times reports (Shear/Pear, New York Times, 1/13). Roughly one-third of the enrollees were adults ages 55 to 64 (Goldstein/Somashkehar, Washington Post, 1/13).

According to the Times, observers are concerned that the new online marketplaces might not be attracting the right mix of young and older enrollees needed to keep premiums costs affordable (Shear/Pear, New York Times, 1/13).

The data also offered the first glimpse at the demographics of enrollees who purchased coverage during the first three months of open enrollment through the 14 state-run exchanges, the District of Columbia's marketplace and the federal exchange, which serves residents in the remaining 36 states. The open enrollment period ends on March 31.

Report Findings

The HHS data show that a total of about 2.2 million people nationwide had purchased private coverage through one of the exchanges by the end of 2013. About 1.8 million of those people signed up for coverage during the month of December, which was a seven-fold increase in enrollment from the total number of enrollments in October and November (Dickson, Modern Healthcare, 1/13).

Obama administration officials noted that they did not yet know how many of the 2.2 million enrollees were previously uninsured or how many have paid their first premium (Washington Post, 1/13).

According to the Times, the 2.2 million figure represents about 65% of the administration's enrollment goal for the exchanges' first year open enrollment period.

In a breakdown of the demographic data, HHS found that:

  • 15% of enrollees are ages 35-54 (Park et al., New York Times, 1/13);
  • 24% are ages 18 to 34;
  • 55% are ages 45 to 64; and
  • 33% are ages 55 to 64 (Shear/Pear, New York Times, 1/13).

Meanwhile, HHS officials said that while the enrollment numbers varied between states, exchanges overall tended to hover around a 20% enrollment rate for young adults. Washington, D.C., had the highest level of young adult enrollment at 44%, while Arizona and West Virginia tied for the lowest rate, at 17% (Kliff, "Wonkblog," Washington Post, 1/13).

Forty-six percent of the enrollees are male, and 54% are female. The data did not specify enrollees' ethnicity or race (Shear/Pear, New York Times, 1/13).

According to Reuters, the young adult enrollment rate was significantly short of a 38% target that the administration set before October 2013, when the federal insurance exchange website -- HealthCare.gov -- launched with a series of systems glitches that caused application problems and delays for millions of people.

Before the launch, officials projected that a total of 2.7 million people would purchase coverage before 2014. Some officials have predicted that the total number of exchange plan sign-ups could reach seven million by the end of the six-month open enrollment period.

On Monday, HHS estimated that more than nine million people have gained some type of coverage under the ACA, including four million who qualified for Medicaid and three million young adults who have coverage under their parents' insurance plans (Morgan, Reuters, 1/13).

Types of Coverage

In addition, the HHS data show that 79% of enrollees qualified for subsidies to help offset the cost of their premiums. Of those enrolled:

  • 60% selected second-tier silver plans;
  • 20% selected third-tier bronze plans;
  • 13% selected first-tier gold plans;
  • 7% selected platinum plans, which have the highest premiums; and
  • 1% selected catastrophic coverage plans.

Administration 'Pleased' With Enrollment, Will Bolster Young Adult Outreach

CMS spokesperson Julie Bataille said the administration was "pleased" with the demographic mix of beneficiaries, despite the lower-than-anticipated enrollment figure for young adults (Modern Healthcare, 1/13).

One official described the data as "solid, solid news" for exchange enrollment and expressed confidence that the demographic mix of young and older enrollees would improve and sustain the exchange economics.

HHS Secretary Kathleen Sebelius said, "We're pleased to see such a strong response and heavy demand," calling the enrollment momentum among young adults "particularly strong."

Some officials also said they are looking to bolster the administration's young-adult outreach efforts in several ways. For example, the administration has hired Marlon Marshall -- deputy national chief for President Obama's 2012 reelection campaign -- to roll out a campaign-style effort to increase enrollment (Shear/Pear, New York Times, 1/13).


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