For younger people, Obamacare signup comes later

This article originally appeared in Politico on November 7, 2013.

By Natalie Villacorta

Everyone knows that a couple of million young, healthy people will have to sign up for Obamacare to succeed. But there’s one big problem with that: They’ll probably wait until the last minute.

While older and sicker people have good reason to more aggressively try to get covered, the younger, healthier people aren’t likely to exhibit much patience with a balky website. They’re likely to put off the mandatory insurance sign up until much closer to the March 2014 deadline.

That means enrollment of these “young invincibles” could be lower for the coming months, and the folks signing up early are likelier to have pricier medical care. This trend could be bad news for the short term as the Obama administration tries to convince Americans that HealthCare.gov is quickly recovering and enrolling people in droves after an awful start. And that gap lets Obamacare critics keep making the case that these “young invincibles” would rather pay a $95 fine than shell out cash for insurance — dooming the president’s signature domestic achievement.

The lousy website is clearly a deterrent. It’s hard to imagine too many healthy 20-somethings sitting around for hours waiting for an error message to disappear.

“Thanks to faster connectivity, instant downloads, streaming services and seamless/tap-to-buy transactions, consumer expectations for speed and ease when it comes to transactions have risen exponentially. This especially goes for the Millennial Generation, which has grown up during the rise of the on-demand economy,” Ann Mack, director of Trendspotting at the advertising and marketing agency JWT, said in an email.

HHS Secretary Kathleen Sebelius acknowledged to the Senate Finance Committee on Wednesday that the first batch of numbers to be released next week will be “very low.” Early reports suggest that few younger people are signing up so far.

One recent study by the Commonwealth Fund found that one in five visitors to the state or federal enrollment sites was aged 19 to 29, and about half were 30 to 49. The Obama administration wants seven million people in the exchanges by the end of March, 2.7 million of them aged 18 to 35.

Even some Democratic supporters of Obamacare worry.

“How are we going to get young people back to look at how they’re going to apply?” Sen. Barbara Mikulski (D-Md) asked Centers for Medicare and Medicaid Administrator Marilyn Tavenner during a HELP Committee hearing this week. Mikulski said that the HealthCare.gov flaws created a “crisis of confidence” that could deter younger people from enrolling.

But backers of Obamacare — and some experts on online consumer behavior — say it’s too soon to panic. Lots could change between now and March 31. Young people are likely to treat enrollment like a term paper — they’ll do it, but at the last minute. After all, according to one online insurance broker, that’s what a fair number of their grandparents shopping online for Medicare plans do: wait until they’re smack up against the deadline.

And e-brokers point out that shopping for insurance isn’t like buying a book on Amazon or a plane ticket on Kayak. Sam Gibbs, president of eHealth Government Systems, said people take their time to understand insurance options and may visit a site repeatedly. It can be a “several weeks or up to a month process,” he said. “This is not a one and done type process.”

When Massachusetts did its own health reform, people typically had 18 interactions — website visits, phone calls or email — before they signed up. The big surge came in the last two months before the state’s individual mandate kicked in.

For Obamacare, enrollment runs through March, although for people who want coverage to start on Jan. 1, the deadline to sign up is Dec. 15.

That December date is why HHS has been messaging about Thanksgiving, encouraging families who gather to talk about their health coverage needs. Lots of advocates are hoping that moms will push their young adult kids to sign up — if the website’s working by then as the administration has pledged. So there could be a spike — and then another one in March.

Skeptics aren’t convinced. They say the bottom line is that health insurance just isn’t that attractive to young people.

“Even if the website were working quite well, it still really does boil down to: Are the products that are being offered sufficiently attractive?” said Joseph Antos, a health policy expert at the American Enterprise Institute and a critic of the president’s health law. Other critics predict “premium shock” when younger people finally get on the website and see what insurance will cost.

Young people have other expenses — car payments, rent, student loans, bar bills — that add up. Even if half of the young and uninsured will only have to pay $50 a month or less for the cheapest “bronze” plans, as a study released by the Department of Health and Human Services found, many will still need convincing.

Erin Hemlin, southern regional manager for Young Invincibles, an advocacy group that backs the health law, said she expected more questions about the glitches at presentations she gives about the Affordable Care Act in the Houston area. But it barely comes up.

“That wasn’t the big problem for them right now,” she said. “They needed a more of an understanding of how the ACA worked and how health insurance worked. The website glitches were more of a small issue that they knew would be resolved eventually,” Hemlin said. She said she spends more time explaining the basics, like defining a premium or a deductible.

At the HELP hearing Tuesday Tavenner said the administration has plans for TV, radio and print media campaigns to draw young people into the exchanges. But they won’t begin in earnest until the website is more reliable.

Some states have started ad campaigns targeting the young and healthy. Colorado, for example, has released “Brosurance” ads that feature a young man doing a keg stand. Oregon’s exchange has released catchy music videos.

These ads may be cute, Antos said, but they don’t convey much substantive information, not enough in his view to really sell young people on the need to buy insurance rather than pay a $95 fine — or 1 percent of taxable income — for going without.

But there are some signs that young people may turn to the online portals for coverage. A 2012 Pew survey found that 24 percent of people aged 18 to 29 had looked online for information about health insurance in the past year, and that was before Obamacare and its subsidies. A Google spokeswoman said that one small study found that 91 percent of people 25 to 34 who were shopping for health insurance had gone online for information.

Anne Filipic, president of Enroll America, which is doing outreach for Obamacare, said at a recent POLITICO event that young people are probably unfazed by website delays. They are used to multitasking while online. HealthCare.gov may be in the background as they work — or look at Facebook or write emails.

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