More thoughts on the HHS December numbers

Yesterday, Charles Gaba examined the big numbers in the most recent HHS report, an unanswered question in the Medicaid numbers and sorted states according to how they’re doing relative to their (admittedly debatable) enrollment targets. Here I would like to briefly mention some rather interesting outliers and other data points, and share a few observations.

There is an 8 % difference between the genders: 54 % of those who have selected a Marketplace plan are women, while men account for only 46 %. Men are in the majority in only two states: Connecticut (54 %) and Hawaii (51 %), whereas the District of Columbia was evenly split per 12/28.

It’s also worth noting that in the District of Columbia, so-called “young invincibles” (enrollees between 18–34 years of age) account for 44 %, while in Massachusetts HHS pegs the portion to be 31 %. Nationally, people 34 years of age or younger account for 30 % of the enrollment, and 18–34 year olds account for just over 24 %.

While a big point has been made of this falling far short of the desired 40 % figure for “young invincibles”, Larry Levitt (Senior Vice President of the Kaiser Family Foundation) scoffs at the claim that this will signal “actuarial doom” – i.e. insurance companies being forced to raise premiums because of the make-up of the risk pool. In a Tweet yesterday, Larry Levitt writes:

With 24% of enrollment among 18–34 year olds, the market is stable and premiums would go up just 2-3%. No "death spiral."

We shall return to the question of age demographics and actuarial risk in a more thorough post – no doubt many times, as it has become a major anti-ACA talking point. But for now, suffice it to say that one of the country’s foremost experts on this issue dismisses the idea. Larry Levitt also underscores another point, which in his opinion has received far too little attention:

Just 1% of enrollees are choosing catastrophic plans. That's good for the risk pool since premiums for catastrophic plans are separate.

Dan Diamond, a well-known columnist on health topics and editor of the Daily Briefing, points out that 75% of New Yorkers enrolled online via the state exchange website. When the statistics become available, it will be interesting to examine other states. These percentages should tell us a lot about how well, or how badly, the various state websites are working.

Another anti-ACA talking point is that enrollees “aren’t paying for those plans themselves”. Larry Levitt addresses this by pointing out that, yes, 79 % of marketplace enrollees will receive tax credits to help pay their premiums – but that this is consistent with projections from the Congressional Budget Office (CBO).

Actually, employers and employees already receive tax credits for company healthcare plans, so this hardly seems unjust.