LOS ANGELES (AP) — Early health insurance exchange enrollment has been lower than the Obama administration predicted, and officials in some states say those who have managed to sign up have generally been older people with medical problems.
Consumers have until Dec. 15 to sign up if they want to be covered on Jan. 1.
Young, healthy people may be more inclined to procrastinate, especially given the reports about problems with the HealthCare.gov enrollment system.
But, if these trends persist, exchanges could have trouble attracting the young, healthy people they need to make exchange plans financially viable.
Insurers have warned that they need a wide range of people signing up for coverage because premiums paid by adults in the younger and healthier group, between 18 and 35, are needed to offset the cost of carrying older and sicker customers who typically generate far more in medical bills than they contribute in premiums.
In California, the state with the largest uninsured population, most of those who applied were older people with health problems, according to a state health care official.
In Kentucky, nearly 3 of 4 enrollees were over 35.
In Ohio, groups helping with enrollment described many of those coming to them as older residents who lost their jobs and health coverage during the recession.
"They have been putting off treatment for a long time, just praying they live until they turn 65 and qualify for Medicare," said Lisa Hamler-Fugitt, executive director of the Ohio Association of Foodbanks, which received federal grant money to help people establish coverage.
That people with serious health conditions would be the first to take advantage of the Patient Protection and Affordable Care Act (PPACA) was expected. But exchange managers are hoping that direction will shift.
In general, someone in his 60s uses $6 in health care services for every $1 tallied by someone in his 20s, said Nicole Kasabian Evans of the California Association of Health Plans. That makes younger adults a coveted group on industry balance sheets.
If those signing up trend to the elderly and sickly "your insurance is going to cost more and that will discourage those younger people from coming in," warned Lisa Folberg, a vice president with the California Medical Association. Faced with steep prices, younger people could opt to pay a government fine rather than purchase coverage.
