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The Young and the Restless

HealthCare.gov’s technical woes are expected to be fixed by November 30th. But, those fixes might come too late for a certain subset of needed enrollees – the young and healthy. The purpose behind the Affordable Care Act’s individual health insurance mandate was to ensure that private insurers would get enough young, healthy people in the system who could offset the costs of covering older and sicker, Medicaid-eligible patients.

Younger people tend to have lower anticipated medical costs; without them in the system, the so-called insurance “risk pools” could become imbalanced and leave insurers with no option but to raise premiums. Higher premiums mean that the young and healthy would be even less likely to sign up, as many in this demographic would choose to pay higher out-of-cost pockets than premiums, hoping that no care is needed. This cycle is known to economists as “adverse selection.”

Even without the website problems, getting this demographic to buy health insurance presents a problem. The White House has relied on micro-targeting techniques (used in the 2008 and 2012 presidential campaigns) to reach young potential enrollees. According a survey by the Commonwealth Fund, a nonprofit research group, only about one in four 19-29 year-olds is even aware that they can use the exchange to find affordable insurance.

This lack of awareness coupled with online enrollment frustrations could lead to significant under-enrollment of young adults. Older and sicker adults have a stronger incentive to keep trying to enroll, despite site glitches, because they anticipate higher costs of care. The young and healthy, after all, could go without insurance and just pay the $95 penalty starting in January 2014.

Demographic information about enrollees is not being released by states or the federal government. Of course, there are alternatives to online enrollment on HealthCare.gov; people can complete the process by paper application or phone. Trying to promote those options to a generation who does everything (i.e., socializing, shopping, banking) online is not ideal. Let’s keep our fingers crossed for a quick fix.

This article is intended as a summary of federal and state law and does not constitute legal advice.

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