News articles claiming Obamacare enrollee population is too small and mix is too old

[Mulligan]

These articles are all over the place so no need to link them. But I wonder if there is a key component that is not being addressed in the statistics and is not been mentioned in any of the numerous articles I have read. That being that many people including myself are taking advantage of being able to stay on their underwritten plan one more year. Is it not possible that these presumably healthy people will all roll into Obamacare and make the mix significantly better for the following year and keep rate increases to a minimum since the government will be giving companies money during this transition time? Also I wonder if the statistics include people who have enrolled directly through insurance carrier, as I imagine they do not.

 

[ziggy29]

In the first year, the penalty for "going naked" is almost nonexistent. I expected this to happen at least in the first year as a result. In future years when the penalty is higher, we may start to see that change a little.

 

[Htown Harry]

I decided not to dig into the articles in any depth.

The headlines and TV news coverage I saw led me to believe the reported raw numbers of enrollees from the "young healthy" and "old and sick" groups generally lacked context. And for various reasons like the one Ziggy mentions, a snapshot at this early time isn't very meaningful.

Wednesday's ruling on the Halbig v. Sebelius case was bigger news, in my opinion.

Nice summary of the case by a law professor here:
Implementing Health Reform: Court Rules That Tax Credits Are Available Through Federal Exchange – Health Affairs Blog

On January 15, 2014, the Affordable Care Act won a very important legal victory in Halbig v. Sebelius. Judge Paul Friedman of the District Court for the District of Columbia held that the ACA unambiguously supports an IRS regulation allowing the agency to issue premium tax credits to individuals enrolled through federal, as well as state, exchanges.

 

[donheff]

These articles are a matter of cup half full or half empty depending on the perspective of the observer. First came the spate of articles claiming that Obamacare was in trouble because the kids are not signing up in big enough numbers. Then yesterday I read Ezra Klien's piece claiming the same report is great news for Obamacare because 1) the youth numbers are virtually identical to Massachusetts' percentages three months in and if the numbers continue to track ACA will meet its goals; and 2) even if the percentages stay where they are Kaiser reports that it would only result in a 2% premium increase. Net result -- no ACA death spiral.

 

[M Paquette]

I've looked at a number of the articles. Most are fairly shallow.

The slow enrollment was actually expected, with considerations made in the structure established by the Affordable Care Act. The insurers and legislative analysts figured it would take about three years for the market to stabilize and the risk pool populations to settle into the expected distributions.

It was anticipated that folks who knew the value and need for medical insurance would be the first ones to sign up, and that the insurance pools would be weighted towards higher risk persons initially. You know, older people like most posters on this forum. Eventually, with education and the cost of not having insurance rising, a broader population will be added to the insurance pool.

A re-insurance program, effectively backing insurers against the temporarily higher risk of the unbalanced individual insurance risk pool, has been established under the law.

ACA Section 1341 establishes a transitional reinsurance program help stabilize premiums for coverage in the individual market during the years 2014 through 2016. The statute requires all health insurance issuers and third-party administrators on behalf of self-insured group health plans to make contributions under this program to support payments to individual market issuers that cover high-cost individuals (payment-eligible issuers).

http://www.cms.gov/cciio/resources/files/downloads/3rs-final-rule.pdf

In other news, the shallow TV news readers complaining about the signup population are shallow. Shocking, isn't it?

 

[Gatordoc50]

Has anyone done any studies as to how many people in each age group even qualify fof the ACA exchanges?

 

[ERhoosier]

No question ACA enrollment to this point has been slower and with a more unfavorable age distribution than both Administration & most pundits predicted. But what I find most shocking is the lack of discussion of the distribution of actual HEALTH STATUS of ACA enrollees. A blind assumption is being made that enrollee populations will have health status with age-related distribution similar to general population. However a population of healthy older folks could be cheaper to insure than group of late 20-somethings with bad chronic conditions. This is the case with Medicare in which 20-somethings with renal failure consume more HC resources than ave healthy 65 yr olds. Obviously actual health status distribution of ACA enrollees will be more difficult to study than simple age distribution & will take much time for data collection & analysis.
IMHO- It is WAY too soon to decide if demographic profile of enrolling population will or will not lead to an ACA 'death spiral'. And I suspect that if a financial 'death spiral' does start there will be major changes in the law to save it, or at least save the US HC system from meltdown.

 

[Mulligan]

Has anyone done any studies as to how many people in each age group even qualify fof the ACA exchanges?

I read one article that had one age band (I forget which one ) was something like almost 80%. But that in itself was one of the reasons I question the reliability of any data. As I assume there are many people like me that will be under the ACA after this year, but I will never enroll through the actual exchange itself as I will never get a subsidy. So I would assume many others like me will not bother to enroll in the exchanges even though we are a part of the system. I wonder if we are ever going to be included in the actual statistics.

 

[Animorph]

I read one article that had one age band (I forget which one ) was something like almost 80%. But that in itself was one of the reasons I question the reliability of any data. As I assume there are many people like me that will be under the ACA after this year, but I will never enroll through the actual exchange itself as I will never get a subsidy. So I would assume many others like me will not bother to enroll in the exchanges even though we are a part of the system. I wonder if we are ever going to be included in the actual statistics.

It would seem a little grasping for ACA stats to take credit for all private insurance holders. Though, except for grandfathered plans, that's about the reality.

 

[Mulligan]

It would seem a little grasping for ACA stats to take credit for all private insurance holders. Though, except for grandfathered plans, that's about the reality.

But that is the part that confuses me. The ACA brings us all under this umbrella (minus the few grandfathered ones), but the statistics will not bear these people out who sign up directly with carriers. For example, the stated goal has been around getting 7 million people to sign up. Let's just say 4 million did sign up in exchanges, but 3 million signed up directly with carriers, it may show as a headline failure, but in reality the goal was achieved. Then on top this, I have read certain carriers will not be part of the exchange, but yet will provide insurance policies. An article I read speculated their mix of customers may be a healthier one and could provide better rates than exchange policies.

 

[nun]

I just went through my ACA application as I'll be leaving my job in March. I'll preface my remarks by declaring that I wanted a socialized medical system or one with far greater controls on insurers and medical providers, so the ACA was a horrendously complicated and unsatisfactory compromise in my opinion and as I live in MA id sort of messed up a system that was working quite well and offered access to almost all residents. Still things are what they are.

The application had lots of parts, but nothing difficult. As I will be living off cash, dividends and some rental income for the next year my MAGI will be under $10k, this makes me eligible for the state Medicaid plan. No account of assets is made. I spoke to a rep and explained the situation and she frankly said she'd heard of a couple of similar situations, but they are so rare that there is no move to adjust things.

I just did the "Wealthometer" link on another thread and came within the top 3% with assets over $1.5M and because I'm frugal and will live on a bunch of cash for a while I get access State subsidized health insurance. I'm a big supporter of social programs and benefits, but I should not be getting them as things are currently arranged. If a truly socialized system was in place I'd have no problem, although I'd probably still get a good deal as my taxes would be low unless they tax wealth...... I now have a moral question to answer, do I just pay for my own insurance or take advantage of the system?

 

[Mulligan]

I just went through my ACA application as I'll be leaving my job in March. I'll preface my remarks by declaring that I wanted a socialized medical system or one with far greater controls on insurers and medical providers, so the ACA was a horrendously complicated and unsatisfactory compromise in my opinion and as I live in MA id sort of messed up a system that was working quite well and offered access to almost all residents. Still things are what they are. The application had lots of parts, but nothing difficult. As I will be living off cash, dividends and some rental income for the next year my MAGI will be under $10k, this makes me eligible for the state Medicaid plan. No account of assets is made. I spoke to a rep and explained the situation and she frankly said she'd heard of a couple of similar situations, but they are so rare that there is no move to adjust things. I just did the "Wealthometer" link on another thread and came within the top 3% with assets over $1.5M and because I'm frugal and will live on a bunch of cash for a while I get access State subsidized health insurance. I'm a big supporter of social programs and benefits, but I should not be getting them. I now have a moral question to answer, do I just pay for my own insurance or take advantage of the system?

Rich people benefit from the tax code, poor people benefit from the tax code, I don't think there is a moral question for you to answer on this. The part I would worry about is the Medicare insurance good enough for your needs, and will the doctors of your choosing accept Medicare patients?

 

[nun]

Rich people benefit from the tax code, poor people benefit from the tax code, I don't think there is a moral question for you to answer on this. The part I would worry about is the Medicare insurance good enough for your needs, and will the doctors of your choosing accept Medicare patients?

My PCP accepts Medicare as does the hospital he's affiliated with. I have now learned that because I am not long term unemployed I might not qualify for the states health plan.....but if that's the case I'll get a very large subsidy to buy from the insurance marketplace.

 

[Animorph]

My PCP accepts Medicare as does the hospital he's affiliated with. I have now learned that because I am not long term unemployed I might not qualify for the states health plan.....but if that's the case I'll get a very large subsidy to buy from the insurance marketplace.

ACA is associated with Medicaid, not Medicare. Not sure if that was just a typo the last couple of posts. I think a lot of providers take Medicare but not Medicaid.

 

[Mulligan]

ACA is associated with Medicaid, not Medicare. Not sure if that was just a typo the last couple of posts. I think a lot of providers take Medicare but not Medicaid.

I did the same thing...thinking Medicaid and typing Medicare...

 

[mpeirce]

They really should have called them something more distinctive.

I guess "medical welfare" and "medical welfare for old people" weren't catchy enough.

 

[nun]

ACA is associated with Medicaid, not Medicare. Not sure if that was just a typo the last couple of posts. I think a lot of providers take Medicare but not Medicaid.

Yes it was a typo.....FYI my PCP accepts both Medicare and Medicaid.

If I do IRA to ROTH rollovers my MAGI will be around $35k and I won't get as big a subsidy. If I hold off on those I'll appear poor and will get a big subsidy, but won't have taken advantage of the low tax IRA to ROTh rollover........head explodes!