With technical renovations on the federal and many state exchanges firmly established, driving enrollment, especially among young adults, is the primary focus of the marketplaces as the March 31 deadline looms closer.
Data on the first three months of HealthCare.gov and the 14 state exchanges showed enrollment picking up, especially following technical repairs of marketplace portals. Still, of the 2.2 million people who had signed up for coverage from Oct. 1 through Dec. 28, just 24 percent were young adults, the age group most prized for the healthy balance that they can bring to the nation’s risk pool and to holding down premium costs.
“We think more young people will sign up as time goes by as was experienced in Massachusetts” when it started its exchange in 2006, said Gary Cohen, director of the Center for Consumer Information and Insurance Oversight and deputy administrator for the Centers for Medicare & Medicaid Services.
“They may have applied but not chosen a plan; may want to think about it; shop around because they haven’t been insured before,” he said in a tele-briefing with reporters. “We are actually very pleased with the percentage that we have so far and we expect that to increase.”
The percentage of young adults who enrolled tracks to the proportion of young adults in the general non-elderly population, the CMS progress report noted. “The general expectation is that people who are older and sicker are more likely to select coverage earlier, while younger and healthier people will tend to wait until towards the end of the open enrollment period,” the report said.
One third, or 33 percent, of the enrollees were 55 to 64 years old, accounting for the largest percentage of those signing up for coverage.
Aaron Smith, co-founder and executive director of Young Invincibles, a nonprofit focusing on issues of young adults, said in a statement that even despite early website glitches and “defying conventional wisdom,” enrollment was well on track to reach even larger numbers of young people. Nationally, 27 percent of young adults 18 to 34 are uninsured, he explained. Most of them will likely be eligible for Medicaid expansion or tax credits.
“We know from the Massachusetts enrollment experience that enrollment rates among the non-chronically ill population spiked in the months preceding the individual mandate, so we anticipate that enrollment rates for this population to increase ahead of March 31,” he said in the statement.
Federal exchange officials have said that it is clear that outreach efforts need to be more robust. “Our outreach efforts have ramped up, so whether it’s through public service announcements, events, our champions or other means, we are doing all we can to find, inform and enroll those who can benefit from the marketplace,” said HHS Secretary Kathleen Sebelius, in the tele-briefing with reporters.
Julie Bataille, a CMS spokeswoman, said that expectations that the young and healthy may wait until the very end to sign up “will be key to our outreach efforts moving forward. We know that the mix is important,” she said. To help with outreach, HHS has 22,000 trained assisters across the country and 12,000 call center representatives.
Getting the word out to make sure that people who are potentially eligible for coverage know about their options remains a challenge, according to a Commonwealth Fund on enrollment progress. “The level of awareness of the marketplaces and financial assistance … was stubbornly stable across the two surveys” between October and December, the report said. “Awareness is lowest among those people who stand to benefit the most” – those with incomes under 250 percent of poverty and eligible for significant subsidies, the report noted.
Halfway through the first enrollment period, only about one quarter of those potentially eligible for coverage under the Affordable Care Act had visited one of the exchanges by the end of December, the report said.
However, young adults show a keen interest in health coverage. About 41 percent of those visitors were young adults, aged 19 to 34. And 59 percent of those in the survey sample who hadn’t yet visited an exchange or applied for coverage anticipated they would enroll in a plan by the deadline.