Obamacare’s youth shortfall

Only about a quarter of new enrollees in the Affordable Care Act’s federal and state marketplaces are under 35, the Obama administration admitted this week—far below the estimated share needed to keep the new health system financially viable in the long term. The administration previously calculated that around 38 percent of new enrollees had to be between ages 18 and 34 to offset the costs of older and sicker enrollees. Figures released this week by the Department of Health and Human Services showed that just 24 percent of the 2.2 million Americans who signed up in the first three months were that young, while a third were 55 to 64 years old. A senior administration official said that age balance was good enough to avoid skyrocketing insurance costs, but House Speaker John Boehner’s office declared the health law “a bust so far.”

It’s no surprise that young people aren’t signing up to “get soaked,” said James Taranto in WSJ.com. If they don’t qualify for subsidies based on income, Obamacare requires them to pay costly premiums in order to subsidize older, less healthy enrollees. The young’s reluctance to do so dooms the system, because without such low-risk policyholders, “premiums can only become less affordable.”

“Republicans haven’t been able to resist the urge to spin the numbers,” said Brian Beutler in Salon.com. These figures aren’t final. The deadline for the uninsured to sign up this year and avoid a federal penalty isn’t until March 31, and previous health-care reform experiences—such as in Massachusetts—strongly suggest that the old and sick rush to sign up first, with the young flooding in only during the closing weeks of enrollment.

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“The big question is what enrollment looks like on April 1,” said Ezra Klein in WashingtonPost.com. While there’ll definitely be more young enrollees, “no one knows how many more.” Until then, new policyholders will have to hope that Obamacare’s built-in shock absorbers—including a $20 billion fund to offset insurers’ losses—maintain stability while “the risk pool sorts itself out.”