More older Americans than young adults so far have signed up for new insurance coverage under the state marketplaces created by President Barack Obama's health care law, according to early data from four states reporting details on their enrollment.
The age balance is being closely watched to determine the financial stability of the insurance market created by the Affordable Care Act, as the participation of younger people is needed to offset costs for sicker beneficiaries. To ensure that younger people sign up, the law requires individuals to pay a penalty if they do not have health coverage.
The Obama administration is aiming to enroll about 2.7 million 18- to 35-year-olds in the exchanges by the end of March, out of 7 million total, or about 38 percent.
Early data from Connecticut, Kentucky, Washington and Maryland show that so far more than 20 percent of the 23,500 combined enrollees in private insurance plans are 18 to 34 years old, ranging from about 19 percent in Kentucky and Connecticut to about 27 percent in Maryland. About 36 percent of enrollees across the four states are 55 to 64. Additional demographic data is expected from California on Thursday.
The federal government last week reported that 106,000 people had signed up during roughly the first month of the enrollment period.
Health policy experts and actuaries said it was premature to draw any conclusions from the initial demographic data, with one likening it to "trying to call an election when you only have 10 percent of the returns."
Still, Steven Schramm, managing director of Optumas, a strategy and actuarial firm that works with state Medicaid programs and exchanges, said 20 percent was surprising at this stage, given that health care advocates were expected to target more elderly Americans at first to make sure they got enrolled.
"We really thought the 55-to-64 percentage would be very high initially," Schramm said. "The first people who show up for any (health care) program are the riskiest people."
A spokeswoman for Kentucky's exchange, which has enrolled a total of 8,780 people in private plans as well as more than 39,000 in Medicaid plans for low-income residents, said it "has been pleased with the enrollment numbers in all age groups."
The experience in Massachusetts, which enacted comprehensive health reform about seven years ago, suggested that younger people would be slower to participate. Evidence in the state showed that, of those who received subsidies, those with health issues joined earlier on, said Rosemarie Day, who was chief operating officer of the Massachusetts Health Connector at the time.
"Healthy people signed up, but they were more likely to wait for the deadline," said Day, who now consults on health care reform programs.
Younger adults are less likely to understand the value of health insurance, so they may need more persuading or information before coming around, Day said. They also tend to be more tech-savvy and inclined to sign up online, so may be turned off by the bad publicity about the problems with the federal website designed to enroll people, she said.
"I would expect them to have a slower trajectory," Day said."I don't think it's any cause for major alarm at this point. It's early in this process - very early."
Insurers in the exchanges can only charge older adults three times as much as young adults for premiums. But per capita health care spending in 2012 for those 55 to 64 years old was $8,920 compared with $2,548 for those 19 to 25, or 3.5 times as much, according to a study of employer-based coverage by the Health Care Cost Institute.
"This is compressing how much rates can vary compared to how much spending itself can vary," said Cori Uccello, senior health fellow at American Academy of Actuaries.
"To help keep premiums more affordable and stable," said Uccello, "it's important to bring in this cross section of risk, including these young and healthy people."