Of the 2.2 million people who have signed up for coverage on federal and state health insurance exchanges, just 24 percent are young adults, the age group most prized for the healthy balance that they can bring to the nation's risk pool to hold down premium costs.
Despite the sluggish enrollment of young adults, Health and Human Services Department officials said in a media call that there was a "strong response to the marketplace" and they were "encouraged" by the numbers from Oct. 1 through Dec. 28 in the progress report released Monday. Young adults were expected to enroll in larger waves closer to the March 31 deadline.
"We think more young people will sign up as time goes by as was experienced in Massachusetts" when it started its exchange several years ago, 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 on the call.
"We are actually very pleased with the percentage that we have so far and we expect that to increase," Cohen said.
The percentage of young adults who enrolled tracks to the proportion of young adults in the general non-elderly population. "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 55-64 years old, accounting for the largest percentage of those signing up for coverage.
As expected, a hefty majority, or 79 percent, selected a plan with financial assistance. And the most popular metal level plan was the Silver plan, selected by 60 percent of enrollees, while 20 percent chose a Bronze plan.
Medicaid enrollment was 1.6 million, although that number does not include additional individuals applying through their state Medicaid agencies or renewing with the program.
Interestingly, 54 percent who signed up for private insurance were women compared with 46 percent men, which could be a product of demographics. However, under the Affordable Care Act, women will no longer be charged more because of their gender, HHS Secretary Kathleen Sebelius noted on the call. "Starting in 2014, being a woman is no longer a pre-existing condition in the health insurance marketplace," she said.
It was clear at the halfway point through the first enrollment period 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," Sebelius said.
Expecting 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," said Julie Bataille, a CMS spokeswoman.
HHS has 22,000 trained assisters across the country and 12,000 call center representatives. Since October, HHS has held more than 2,000 public education activities around the country to help spread the word about coverage options.