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Home Publications Blogs Beat the Press Washington Post Didn't Get the Memo: Health Care Exchanges Don't Need Young People

Washington Post Didn't Get the Memo: Health Care Exchanges Don't Need Young People

Wednesday, 25 December 2013 07:59

It's hard to get news over at Fox on 15th Street, buried away in downtown Washington, five blocks from the White House. That presumably is why the Washington Post had a front page article discussing the extent to which young people are signing for the health care exchanges set up under Obamacare. The piece reports on the outreach effort to sign up:

"the healthy Americans in their 20s and 30s who are key to making the economics of the new health-care law work."

In fact there is not a special need to sign up young healthy people as opposed to healthy people of all ages. Kaiser Family Foundation did an analysis last week showing that it would have relatively little impact on the cost of the program even if the number of young people enrolling fell far below their share of the population. While young people do have lower costs on average, they also pay lower premiums. While these are not completely offsetting the difference will have little impact on the costs of the program.

The conclusion of the Kaiser study is that the exchanges need healthy people of all ages. It doesn't especially matter if they are young. (A healthy 55-year-old pays three times as much as a healthy 30-year-old.) The real concern is a skewing based on health status, not age.


Comments (8)Add Comment
written by Sirius_TheStarDog, December 25, 2013 12:40
Curious to know how this meme got started because it certainly has become conventional wisdom.
written by watermelonpunch, December 25, 2013 1:02

They're going to beat that dead horse in some media outlets.

Meanwhile, my spouse said he saw the local newspaper this week someone was reading at work. The Scranton Times. And the front page article about obamacare was what he described as a "What if?" piece that seemed to focus totally on worrying about legions of people who might sign up for high deductible plans without knowing it, and not know what they're in for.


I assume this is the article:

First, Pennsylvania has been reported as having, relatively low priced exchange plans compared to many states. So what people in Illinois or Kentucky are looking at might be very different than in PA.

People were more likely to not know what they were in for, and to have higher deductibles, before Obamacare.

Also, though the Marketplace web site has had numerous issues, the layout is not mysterious when it comes to plan details.
When you choose between plans, there are certain figures that you cannot miss - they are at the top label of every plan. Premium, Copays, Deductible, and Out of Pocket Maximum.
You would have to be blind not to see them, and completely determined to be ignorant to then not find out what "Deductible" means if you don't already know.

Many people signing up through the exchange... They're doing so because of the tax credits. Which means a lot of people are not going to be paying hundreds of dollars per month for their premiums only to have high deductible plans. They will have tax breaks (like people who get tax breaks by getting it through their employers!).

Furthermore, people of more modest incomes will not only get premiums largely (or totally) covered, but also qualify for "reduced cost" deductibles & copays on Silver plans.
This seems to be the best kept secret from the media about the Marketplace plans purchased through the exchange.
I've yet to see any newspaper articles that really lay out just how attractive these reduced costs are for modest income individuals.
Apparently newspapers don't care about reporting to or about people whose income falls below 250% of Federal Poverty level.

Sorry to go off on a tangent here. I'd still rather a system that my pals in other wealthy countries enjoy.

But the fact is, young &/or health people of modest means needing health insurance in Pennsylvania, would be FOOLS not to at least check out their options in the Marketplace exchange.

Anecdotal... but I happen to know of several young healthy uninsured people who know they have until March to get signed up to avoid the penalty, and are waiting to see how the Marketplace plan works out for us before even attempting it.
So personally I'm not caring anything about the early numbers, and won't even start paying attention to the young people sign up rate until April, since I think before that, it's nearly meaningless, even if it was at all important!

And that there will be many people, both young & old, who will fail to learn about their options, or understand what they're purchasing for that matter, is a fact of human existence. There will always be people who remain ignorant, or make bad choices.
If we made it a law under ACA that everyone get super-informed about health insurance details, then you'd have people screaming that we have a nanny state.
written by Albertsonstirfry, December 25, 2013 2:10
But today's young healthy people are more likely to be healthy tomorrow than today's older healthy people are. That's obvious. Isn't that why so much emphasis on youth?
Nope Albert
written by Ann, December 25, 2013 10:18
RE: written by Albertsonstirfry, December 25, 2013 3:10

But today's young healthy people are more likely to be healthy tomorrow than today's older healthy people are. That's obvious.


No it is NOT obvious. I'm 59, 5'2", 98 lbs (haven't gained an ounce since senior in high school) still a Size 2..... blood presssure so low, they always check it twice....

ANd what I see on the beaches here where we get 2,300,000 tourists in the summer are FAT late teens and 20-somethings and 30-somethings. 8 out of 10 females in those age groups should never wear a bikini - they look 3 to 4 months pregnant with the rolls of blubber in the middle.

The 20-somethings are the the early edge of the "kids with diabetes from being fat" wave.

They sit inside on electronics. They watch TV and videos. They ride everywhere. They eaat truly gross stuff like fast food and swill down Mountain Dew and sugar loaded energy drinks.

I do 5 miles on the beach 3-4 times a week. Use an old fashioned 'no gears bike" around the neighborhood. And I get nauseated even thinking about fast food or energy dirnks.

SO no - one can not assume they are "healthier"
written by watermelonpunch, December 26, 2013 1:57

Wow Ann, tell us how you really feel.

Aside from Ann's point.

The point here is that the media is failing to point out that health care insurance prices are NOT based on health.

They're based on age.

Even a 59 year old total health nut (ahem) who uses very little medical services, is going to pay 3 times as much as an obese disease ridden 26 year old with a decadent lifestyle, making hefty regular usage of medical services for everything from diabetes to the clap.

It's a peculiar way to be remiss, since the entire major catalyst to get the ACA was to stop exactly that - price discrimination on health. Not to stop price discrimination on age.
written by Kat, December 26, 2013 10:47
Using ageism to fight ageism is not particularly helpful. Adding sexism to the argument even less so. Do I even need to mention how classist fat phobia is?

True enough, the ACA will hurt a great many people, not just the young
written by Rachel, December 26, 2013 11:26

People who live in rural areas, for whom health care is not so available, are forced to pay for people in the suburbs who have more services. Many "lower class people," who are obliged to belong to HMOs, notorious for undertreating patients, end up subsidizing more fortunate people. People who deal with potential health issues responsibly, like Ann, are obliged subsidize the irresponsible. And people who are close to poor but healthy, have to give to the less poor. For that matter, people trying to accumulate some cash to fund future surgery will now find the ACA cutting into their savings, because they are obliged to help pay for other peoples' contraceptives, or their problems with depression, or acne. So a great many people are going to be hurt by this regressive and very inefficient tax.
It's not just the young
written by watermelonpunch, December 26, 2013 11:43
Do I even need to mention how classist fat phobia is?

Not to mention the fact that not all overweight people are eating poorly or non-nutritious foods.

And not all overweight people have any serious health problems.

While excess obesity is of course often correlated with certain health problems, sometimes obesity is CAUSED BY those health problems.

And many skinny young people have been hit with very costly medical problems, through no fault of their own.

I happen to know a thin woman in her early 30s who got breast cancer. She has the genetic marker (BRCA) for the cancer, inherited.
There's nothing anyone can point to about her eating or her lifestyle, or her age, that caused this to happen to her.

12 year olds & 52 year olds can, thin or stout, can be hit with an appendicitis.

And just driving on the highways regularly to commute puts you at greater risk for serious medical needs, more than the person who stays at home most of the time.
I mean if we're going to start nitpicking about people's lifestyle choices regarding insurance risks... we may as well consider charging people with a history of traffic moving violations more for their health insurance.

But we don't want it to work that way - WITH GOOD REASON.

Even the American Cancer Society (who is about as anti-smoking as you can get), is against charging smokers more for health insurance.

Before the ACA... if you had a pre-existing condition such as a prior cancer or even just slightly high blood pressure, you could face steep price discrimination.

Now, you're only discriminated against for age & smoker/non-smoker status.

Interesting to note that the Marketplace plans I viewed - none of them cover "bariatric services" (which I learned refers to weight-loss surgeries such as gastric bypass).
If the insurance companies really thought just slimming down would be very effective to prevent other costly health problems, methinks they'd be covering bariatric services, weight loss programs, & dietician visits.
Apparently they don't think just slimming down or eating more healthy diet, is a sure enough bet.

But actually, at least the (local to me) Geisinger plans (including Marketplace plans), all come with access to discounts on health club gym memberships & discounts for Weight Watchers membership.
They also have a plethora of other "accessories" discounts that have nothing to do with diet or weight (such as eye exams & acupuncture), so I'm assuming this isn't proof they're trying to actually encourage exercise or weight loss.

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About Beat the Press

Dean Baker is co-director of the Center for Economic and Policy Research in Washington, D.C. He is the author of several books, his latest being The End of Loser Liberalism: Making Markets Progressive. Read more about Dean.