Health Care

Obamacare 2017: More women than men but young consumer sign-ups still lag

In this 2015 photo, a man advertises Affordable Care Act Coverage in Miami. The Obama administration on Tuesday reported for the first time demographic information for consumers who have signed up for coverage on the Affordable Care Act exchange at healthcare.gov. More than 1.6 million Floridians signed up for coverage as of Dec. 24.
In this 2015 photo, a man advertises Affordable Care Act Coverage in Miami. The Obama administration on Tuesday reported for the first time demographic information for consumers who have signed up for coverage on the Affordable Care Act exchange at healthcare.gov. More than 1.6 million Floridians signed up for coverage as of Dec. 24. MIAMI HERALD STAFF

With Congress poised to begin a fast-track repeal of the Affordable Care Act this week, and the Jan. 31 deadline approaching for consumers to enroll in a plan, the Obama administration on Tuesday reported, for the first time, the age, ethnicity and gender of the 11.5 million Americans who have signed up for 2017 coverage under the law better known as Obamacare.

Enrollment in the 50 states plus Washington, D.C., has outpaced the same period from last year by about 286,000 people, according to the report — evidence of growth that the U.S. Department of Health and Human Services seized on to refute claims by congressional Republicans that the ACA’s insurance exchanges are in a “death spiral” and will eventually implode.

“Today, we can officially pronounce death spiral claims dead,” said Aviva Aron-Dine, a senior counselor for HHS, during a teleconference with reporters on Tuesday.

In Florida, more than 1.6 million people signed up through Dec. 24 — the most of any of the 39 states using healthcare.gov. The Florida demographic breakdown: 891,939 females and 742,675 males, including 111,322 children, 431,771 adults between 18 and 34, 652,605 adults between 35 and 54, and 438,916 older than 55.

Race and ethnicity reporting for ACA exchange customers is voluntary. But when the information is reported, whites far outnumber every other group among Floridians who signed up, with 439,641 identified as Caucasians, 308,767 Latinos, 117,185 African Americans and 60,002 Asians.

Nationally, 3.9 million whites have signed up for coverage, compared to 882,000 Latinos, 584,000 African-Americans and 573,000 Asians.

Among all Floridians who signed up this year, 416,327 are new customers and 44,553 are categorized as “rural Floridians”.

As in past years, younger adults have not signed up for ACA plans at the rate that advocates and proponents of the health law had hoped.

Of the 11.5 million, about 3 million — roughly 26 percent, according to HHS — are between the ages of 18 and 34. In Florida, adults in that age group make up about 26 percent of the total enrollment through Dec. 24.

Young adults are key to the success of the ACA insurance exchange, health economists say, because young people tend to be healthier, which helps spread the financial risk of coverage.

And because the ACA restricts how insurers price their coverage — premiums for the oldest consumers can be no more than three times the amount charged to the youngest consumers — older adults on average pay premiums that do not fully cover their expected medical expenses while younger adults pay premiums that more than cover their expenses.

If enrollment among young adults falls short, then insurers are more likely to raise premiums to make up for the loss.

For 2017, the fourth year of the ACA exchanges, premiums rose more than they had in the past two years.

Across the 39 states that use the federally run exchange at healthcare.gov, the average increase in premiums for all plans was about 25 percent. In Florida, which uses healthcare.gov, the average rate hike was 19 percent.

Aron-Dine said the higher premiums for 2017 reflect a “one-time adjustment” by insurers on the ACA exchange who initially under-priced their plans to attract more consumers. Insurers also raised premiums for 2017 to prepare for the scheduled sunset of the health law’s transitional reinsurance program, which limits insurer losses and gains by subsidizing health plans that enroll higher-cost consumers.

“They’re about the right size to bring premiums on track with costs,” Aron-Dine said the 2017 hikes.

Christen Linke Young, a senior official with HHS who also participated in Tuesday’s call, said ACA premiums are likely to spike in the future if congressional Republicans pursue a strategy of repealing the health law and then delaying a suitable replacement.

If health insurers do not know what the insurance market will look like going forward, then many will raise premiums or stop selling coverage on the exchanges, Young said, citing a recent letter from the American Academy of Actuaries to leaders in the U.S. House of Representatives warning of the consequences of repealing the health law and eliminating subsidies for eligible consumers to buy coverage on the ACA exchanges.

“There would be immediate negative consequences,” she said.

A previous version of this article misreported the number of people between the ages of 18 and 34 who have signed up for 2017 coverage on the Affordable Care Act's insurance exchanges in all states. The correct number is 3 million.

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