Slim Ranks of the Young and Healthy Don't Faze Obamacare Insurers

Now that Obamacare enrollment has closed, insurers are tallying their new members. The White House hyped a late surge in enrollment by young people, which the system needs to keep premiums stable. Nationwide, 28 percent of the 8 million new enrollees are in the young-invincible demographic of 18-to-34-year-olds.

Still, the story varies considerably from state to state. In 16 states, the share of young adults enrolled stands at 25 percent or less. Each state serves as its own risk pool under the Affordable Care Act—if a bunch of healthy people sign up for insurance in North Carolina, that doesn’t help offset anybody’s medical costs in Wisconsin. So should people in states where the risk pool skews older be worried?

West Virginia would be the place for worriers to start. Just 19 percent of the state’s exchange enrollees are young adults, according to data the federal government published last week. That’s the lowest proportion in the U.S.:

West Virginia already lands toward the bottom in many statewide health indicators (PDF), and the 20,000 residents who bought plans on fell short of expectations. Separate calculations from consulting firm Avalere Health and the Urban Institute found the state short by at least one-third of projected enrollments. Local conspiracy theories about implanting microchips into Obamacare customers probably didn’t help turnout.

Those numbers don’t look like cause for concern to Fred Earley, president of Highmark Blue Cross Blue Shield of West Virginia. His company was the only one in the state to offer plans on the health exchange this year. Earley notes that West Virginia’s population skews older: “What we’re seeing on the exchange and what’s been reported was not too far off of what we were anticipating,” he says.

Earley wouldn’t comment on rates for 2015, which Highmark is now preparing to file with regulators. He also says that most of his new insurance customers are paying their premiums. Nonpayment rates that spiked above 10 percent have dropped to 6 or 7 percent, although he cautions that the rate for last-minute buyers is still unknown.

Low overall enrollment wasn’t synonymous with a dearth of young adults. Massachusetts, hobbled by a malfunctioning website, badly missed its projected enrollment, according to the Urban Institute. Yet 18-to-34-year-olds still made up 29 percent of the state’s risk pool. And large states that include California, New York, and Texas all recruited at least 28 percent from the young invincibles. In Washington, where members of Congress and their staffers were required to buy on the exchanges to prove a political point, bright young things are 45 percent of the total.

Young adults make up 40 percent of the uninsured population, according the Kaiser Family Foundation, but even if they enroll in far smaller numbers, the health policy group estimates that the effect on premiums will be modest. If they make up 25 percent of the risk pool, that would likely push premiums up a couple of points. “Well below the level that would trigger a ‘death spiral,’” Kaiser researchers wrote in December.

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