Filed Under:Markets, Employee Benefits

PPACA enrollee health more critical than age

(AP Photo/Wilfredo Lee)
(AP Photo/Wilfredo Lee)

Experts have repeatedly said participation by young, healthy adults in health plans under the Patient Protection and Affordable Care Act is vital to the success of the law.

But new research now says, well, maybe not.

The Commonwealth Fund reached that conclusion this week in a report that examined thoughts from actuaries, insurers, health policy researchers and federal officials. They concluded the overall health status of enrollees is more important than age to premiums.

“The role of young adults has likely been overemphasized,” said Sara Collins, report author and Commonwealth Fund vice president. “Their participation is important, but lower-than-expected enrollment this year won’t trigger market failure.”

Related story: Uninsureds ready to pay penalty

The report comes after less-than-impressive figures from the Obama administration on participation by young adults in PPACA. Though the administration's latest numbers show more young adults are enrolling, the numbers remain much lower than initial projections.

Health care experts have said young adult participation in PPACA plans is needed to offset older, and likely sicker, individuals to offset the price of premiums. President Obama asked young adults to sign up for coverage under his law during his State of the Union address.

According to Gallup, the uninsured rate for adults 26- to 34-year-olds sits at 25.7 percent, making them the largest segment of uninsured.

Though participation by that age group is important, Commonwealth Fund researchers concede, it’s not the most important and just one of many factors.

“There is no single ‘right’ rate of young adult participation that will guarantee success,” the report said. “In fact, health plan actuaries view health status for all age groups as being more important in their pricing decisions.”

What’s more important is the health status of the overall enrollment pool. Researchers said health status of the newly enrolled across all age groups is a more uncertain and important factor in determining premiums.

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