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Young millennials shun Obamacare, creating risky imbalance

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Less than one-third of uninsured young Americans say they are likely to sign up for health insurance in the Obamacare exchanges, according to a Harvard University Institute of Polling survey Wednesday that signals President Obama's sales pitch to a key group of his supporters is falling short.

Younger Americans are critical to the success of Obamacare. Insurance companies are counting on healthy consumers to enroll in the system and fund health care for older, sicker patients who create a net drain on the insurers. The Affordable Care Act prohibits insurers from denying coverage for pre-existing conditions and ends caps on payments.

The Harvard institute found that only 29 percent of uninsured people ages 18 to 29 will "definitely" or "probably" enroll through exchanges set up under Obamacare. When the pollsters switched terminology and asked whether the respondents would sign up under the Affordable Care Act, the number dropped to 25 percent.

"The young and healthy are not signing up, which is bad news," said Rep. Kevin Brady, Texas Republican. "Without the right mix of young and old, healthy and sick, health care premiums for 2015 will skyrocket, access to care will become more limited and insurers may no longer offer coverage."

For months, Obamacare supporters have argued that young people do want health care coverage.

Mr. Obama rebutted skeptics Wednesday during a youth summit designed to whip up support for his signature health care law.

"If you're a student body president, set up a conference on campus. If you work at a nonprofit, open your doors and use your email list to help people learn the facts," he said. "If you've got a radio show, spread the word on air. If you're a bartender, have a happy hour — and also probably get health insurance because a lot of bartenders don't have it."

It's not the first time officials mixed booze and Obamacare in an attempt to lure the young and fit to the exchanges.

Colorado's exchange caused a stir this year by releasing a "Brosurance" ad that depicted young men doing a keg stand. One Republican lawmaker asked Health and Human Services Secretary Kathleen Sebelius whether she thought the ad was appropriate. Mrs. Sebelius noted that the ad was state-based, not federal.

Young professionals and Obamacare are forming a volatile mix on Capitol Hill, where fear of a "brain drain" from a provision that forces lawmakers and their staff into the exchanges elicited a series of rules to protect staffers who cannot afford insurance premiums without employer-based subsidies.

Senate Majority Leader Harry Reid, Nevada Democrat, took flak from Republican quarters Wednesday because he, unlike other congressional leaders, opted to exempt some of his leadership staff from the exchanges.

A Reid spokesman said the senator was "just following the law" because the provision in Obamacare differentiates among types of staff.

The Harvard report, part of a broad look at "millennial viewpoints," said 56 percent of young adults disapproved of the health care overall, compared with 39 percent who expressed approval.

Under Obamacare, most of those who aren't covered by insurance will have to pay a tax penalty. The penalty is as low as $95 for a single adult in the first year and rises to at least $325 in 2015 and $695 in 2016.

If young adults choose to pay the penalty rather than buy coverage, insurers might have to raise premiums at the end of next year, which could trigger what analysts call a "death spiral" — ever-increasing premiums, which would chase more people out of the market and further undercut the reform effort.

A Gallup survey released this week painted a rosier picture for the law than Harvard's study. It found that young people are not significantly more likely than older people to pay the fine rather than buy coverage.

Among respondents younger than 30, 68 percent told Gallup that they would acquire insurance — it does not specify whether it would be through an exchange — and 26 percent say they would pay the fine. Those 30 and older produced a 60 percent to 30 percent split.

"The fact that younger uninsured Americans are no more likely than older uninsured Americans to say they will pay the fine could be a positive sign for the law's ability to keep insurance affordable," Gallup said, "assuming that the younger uninsured are no less healthy than the older uninsured."

Government subsidies are available to help low- and middle-income Americans pay their premiums on the exchanges, and Democrats frequently note that young adults can stay on their parents' health care plans until age 26.

The exchanges have been open for more than two months, but the HealthCare.gov portal, which is handling enrollment for most of the country, has been plagued by problems.

Early enrollment figures from the federal government don't give details by age. The Centers for Medicare and Medicaid Services said Wednesday that the next batch of enrollment information would be released in mid-December, but it is unclear whether the new tables will incorporate age data.

A CMS official said the agency has "prioritized reporting of the metrics which provide the most accurate snapshot of Marketplace enrollment-related activity at this time," and "will provide additional metrics when we are able to."

Some state-run exchanges are releasing age-related figures.

Enrollees up to age 34 made up 28 percent of the California exchange's enrollment as of Nov. 6, with those 35 and older accounting for the remaining 72 percent. The exchange said those figures align with the state's population.

"Not only are we seeing strong enrollment numbers overall, but enrollment in key demographics like the so-called young invincibles is very encouraging," Covered California Executive Director Peter V. Lee said Nov. 21.

In Minnesota, enrollees up to age 30 made up about 23 percent of enrollment, those ages 30 to 50 comprised 28 percent, and those 51 and older accounted for 49 percent through Nov. 30, according to an MNSure Metrics report.

Kentucky's state-run exchange, kynect, also touted positive figures this week.

"Thanks to kynect," officials said, "more than 60,000 Kentuckians are enrolled in new health insurance, and 41 percent of them are under the age of 35 — a rate that has held steady for several weeks."

Ben Wolfgang contributed to this report.

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