Low ACA Enrollment Among Young Adults Prompts Final Push

Obamacare advocates are working to mobilize young adults, a demographic that's key to the Affordable Care Act’s success, to sign up for insurance through the federal marketplace ahead of the March 31 deadline for open enrollment. But with sign-ups among 18- to 34-year-olds lagging behind expectations nationally, pro-reform groups are targeting Texas — with its large, youthful population — in an effort to up their numbers.

In February, for the second consecutive month, young adults made up 27 percent of those who had successfully purchased coverage through the online insurance marketplace in Texas, compared to 25 percent of those who enrolled nationally, according to data from the U.S. Department of Health and Human Services.

The Obama administration has said that young adults — who are generally healthy and have fewer medical costs — should make up 40 percent of those insured through the marketplace to offset the costs of older, higher-risk patients and keep premiums down. 

“The next couple of weeks are going to be instrumental,” said Sara Smith, program director for the pro-ACA Texas Public Interest Research Group, which advocates on consumer issues. “We have two weeks to inform the state’s most uninformed health care consumers.”

John Davidson, senior health care policy analyst for the conservative Texas Public Policy Foundation, said that will be a futile battle, given that costs for young people under Obamacare aren't minimal. 

“The ACA was sold as something that would make health care cheaper. A lot of people are going on the exchange expecting their plans to be free or very inexpensive, and that’s just not the case,” he said. “...Young, healthy people aren’t going to want to pay rates like this, especially if they don’t have to go to the doctor." 

Before the implementation of the ACA, insurance companies often charged a five-to-one ratio or higher for monthly premiums based on a consumer's age, according to America’s Health Insurance Plans, the national trade association representing the health insurance industry. The new law limits this ratio to three to one. In order to make this system work, the Obama administration has said that young adults need to enroll at high enough rates to yield a surplus in premium revenue — which insurance companies can then allocate to help cover the expected deficit created by lower premiums for older patients. 

The Texas Public Interest Research Group started its campaign, Health Insurance 101, to give young adults information on their health care enrollment options. They have canvassed on Texas college campuses, hired student interns at several schools and pushed university officials and student body leaders to send out the group's information guide and email reminders about ACA deadlines. 

Smith said the group is also focusing on future users of the marketplace: “Maybe they are a 24-year-old senior on their parents’ plan. They aren’t always going to be that way,” she said.  

Another national pro-ACA group, Young Invincibles, was a presence at the recent South By Southwest festival in Austin, and has established enrollment stations at bars in the state's urban areas. The group also created an app called Healthy Young America that can be used to calculate premiums and find health care services. 

“We rarely have young people tell us they don’t want to sign up," said José Sánchez, the group's southern regional organizing director. "It’s usually that they didn’t know about the deadline or subsidies." 

Supporters of health reform are hopeful there will be a surge in sign-ups among young adults in the final days of the open enrollment period. “I’m confident that these numbers will spike before the deadline,” said Stacey Pogue, a senior health care policy analyst for the liberal Center for Public Policy Priorities.  

If they don't, the ACA has protective measures built in to avoid major increases in premiums for the first two years. A study by the Henry J. Kaiser Family Foundation concluded that if rates among young people stay at around 25 percent, it will not be catastrophic for the system — but insurance companies would likely increase premiums to protect their profits.

Davidson, with the Texas Public Policy Foundation, said he believed cost was the top impediment for young people seeking health coverage. For example, according to the Kaiser Family Foundation subsidy calculator, a single 25-year-old making $20,000 per year and living at 174 percent of the federal poverty line would need to pay $1,021 each year for coverage — and that's after the government subsidy. 

If young people were suddenly going to start enrolling in large numbers, Davidson said, "we would have seen it by now.”

This story was produced in partnership with Kaiser Health News, an editorially independent program of the Henry J. Kaiser Family Foundation, a nonprofit, nonpartisan health policy research and communication organization not affiliated with Kaiser Permanente.