Health

Calif. Health Exchange Enrollees Trending Older

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Dr. Jason Greenspan (L) and emergency room nurse Junizar Manansala care for a patient in the ER of Mission Community Hospital where doctors held a press conference outside on a class action lawsuit against the state of California by a coalition of emergency room physicians claiming that without additional funding, the entire emergency healthcare system is on the verge of collapse on January 28, 2009 in Panorama City, California. (David McNew/Getty Images)

A doctor and a nurse treat a patient in a hospital emergency room. (David McNew/Getty Images)

CBS SF Bay (con't)

Affordable Care Act Updates: CBSSanFrancisco.com/ACA

Health News & Information: CBSSanFrancisco.com/Health

SACRAMENTO (AP) — Initial enrollees in California’s online health insurance marketplace are trending older, according to a report released Thursday that provides the first detailed look at those who are seeking policies under the Affordable Care Act.

The report from Covered California, which operates the exchange, says 30,830 people had enrolled in October, the first month of operation. The pace of enrollments has been accelerating since then.

About 56 percent of those were in the 45- to 64-year-old category. Just 23 percent were age 18 to 34, a younger and typically healthier demographic that insurers say they need to make the policies financially viable.

The numbers do not include those whose incomes are so low that they qualify for Medicaid, the state-federal health insurance program for the poor.

Covered California Executive Director Peter Lee said he expected older people to sign up in greater numbers during the early days of the exchange, as people with pre-existing conditions who had no previous insurance flocked to the site.

The proportion of those ages 45 to 64 signing up for health coverage on the exchange far outweighs their representation in California’s total population, which is 25 percent. The percentage of younger people enrolling for coverage is roughly proportional to their representation in the state’s population.

“We’re already seeing young people enroll in large numbers,” Lee said during Covered California’s board meeting.

Yet he did not say whether insurers and the exchange had a goal for the number of younger people they wanted to sign up.

Enrollees are defined as those who have selected an insurance policy but might not have actually paid for it yet. The number of people who have selected an insurance policy had risen to nearly 80,000 as of Tuesday, although the Covered California report did not provide a demographic breakdown for that larger group.

Of those who had chosen a plan by the end of October, 85 percent spoke English, 3.9 percent spoke an Asian language and 3.2 percent spoke Spanish. Thursday’s report also provided limited information about the health plans being chosen. Four major insurers — Anthem Blue Cross of California, Blue Shield of California, Kaiser Permanente and Health Net — accounted for 96 percent of all individual health plans being selected.

There was no breakdown for the types of plans that were most popular. Plans are designated as bronze, silver, gold and platinum under the Affordable Care Act, with the cheapest of those having lower premiums but higher deductibles.

Health exchange officials have said they expect most people to shop for coverage during the first month of open enrollment but select specific plans later. Dec. 15 is the deadline to have health insurance by Jan. 1, but the open enrollment period extends through March 31.

Lee said younger people were expected to wait until the last minute to sign up for coverage and said a sustained marketing campaign is need to reach them.

Insurers have warned that they need a wide range of people signing up for coverage because premiums paid by adults in the younger and healthier group are needed to offset the cost of carrying older and sicker customers, who typically generate far more in medical bills than they contribute in premiums.

Later Thursday, the board was expected to announce California’s response to President Barack Obama’s flip on one provision of the Affordable Care Act.

Obama said he is extending the end-of-year expiration deadline for existing individual policies that do not meet the higher benefit standards of the new federal law so people do not lose policies they like.

Covered California already had worked out a deal with insurance companies to end those policies by Dec. 31, and insurance companies have said extending older polices that already have been discontinued will create numerous problems. States’ responses to Obama’s extension have been mixed, with many of those running their own health care exchanges saying they will not follow the president’s advice and will let the older policies expire.

Covered California’s options include not making changes, allowing insurance companies to extend current plans through the end of March or allowing insurers to extend them through the end of 2014. No matter what action the board takes Thursday, Lee said the state cannot force any insurance companies to extend their already expired plans.

Officials described myriad complications if the board agreed to modify the existing contract that Covered California has with the state, including how much premiums could rise, whether consumers might be subject to two deductibles in one year and the tight timeline in which to make a decision, with the end of the year quickly approaching. Insurance companies would need to re-offer the old plans before Dec. 31.

“Covered California has spent a lot of time structuring a market that is best for consumers,” Lee said, cautioning that any changes could upset the intended fairness of the system.

State Insurance Commissioner Dave Jones estimates that 1.1 million termination notices have gone out in California. He previously agreed with two insurers to extend their deadlines for older policies. He was able to force the extensions because the insurers had missed state deadlines for sending the expiration notices to policyholders.

So far, the Affordable Care Act has fallen far short of expectations in overall enrollment. The first set of data revealed that 106,000 people signed up for coverage nationwide during the first month of enrollment, fewer than the roughly 500,000 initial sign-ups the Obama administration had expected.

Just a handful of states have released detailed enrollment figures, all of which show older people signing up first. In Connecticut, six in 10 of those who have enrolled in private insurance are between 45 and 64 years of age. In Kentucky, nearly 3 of 4 enrollees were over 35. And in Washington state, less than a quarter of enrollees were between 18 and 34.

(© Copyright 2013 The Associated Press. All Rights Reserved. This material may not be published, broadcast, rewritten or redistributed.)

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