In California, a state considered crucial to the success of the Affordable Care Act, older people are starting to enroll in the new health insurance marketplace in large numbers - as expected. But a demographic breakdown released Thursday of the early sign-ups suggests younger people are showing up in force, too.
About 56 percent of the Californians who signed up for insurance in October are 46 or older, according to data released at a Sacramento board meeting of Covered California, the state's health insurance exchange. And nearly 23 percent of the enrollees are between 18 and 34 years old. Older people make up a higher percentage of enrollees than they do of the state's total population, while the proportion of younger enrollees more or less reflects their numbers statewide.
Peter Lee, who directs California's insurance marketplace, says he is pleased at the number of young people who are already enrolling because it bodes well for the cost of California insurance premiums in 2015.
"Our sustainability in the long term is about having a good risk mix," Lee says. And, in general, younger people need to seek care from a doctor or other health professional less often than older people do.
Perhaps even more important than age, however, will be how healthy or unhealthy the enrollees prove to be — regardless of how old they are. People who are sick, researchers say, are more motivated to sign up early because they may have imminent health needs; and some may have been previously locked out of the insurance market. They are more likely than healthy people to be willing to put up with application problems — online and in person — months before they will see any actual benefit.
"There is a whole group of people who would like to get into health insurance who have been held at bay," says Deborah Chollet, a senior fellow at Mathematica Policy Research. "It has been an unfriendly market."
Throughout the nation, the Affordable Care Act does not allow insurers to reject people with preexisting conditions. The health status of California's new enrollees won't become clear until insurance companies start seeing claims next year.
One Californian, Jesse Crall, has been uninsured since he graduated from UCLA last year. Crall is 23 and, though otherwise healthy, has depression and attention deficit disorder. Each month, he pays $760 for therapy and $300 for medication.
Crall lives in Hollywood. He says he went online to sign up for health insurance as soon as Covered California opened for business, though he had to send in additional paperwork before his application could be processed. "I want this to go into effect as soon as possible," he says. "I need a plan that cuts these costs."
The data released Thursday highlight one steep challenge for California officials: a poor turnout among Spanish-speaking consumers. Just 3 percent of those signed up in October said they speak primarily Spanish, compared to about 29 percent of the total population in California. The number of Spanish-speaking enrollees is expected to increase over time, Lee says, because more than half of the enrollment counselors speak Spanish.
Also, advertisements for the marketplace are running in Spanish, and there is a Spanish-language version of the marketplace website. Plus, several advocacy groups are doing outreach and education in Latino communities.
But health reform advocates say that Latinos, who make up about 60 percent of the uninsured in the state, may be slower to apply because of the delay in getting enough Spanish-speaking enrollment counselors certified or because of a lack of education about the law.
Marian Mulkey, who leads health reform research at the California HealthCare Foundation, says California officials should be concerned. Latinos, she says, are a "pretty big part of the target population."
Policymakers and health officials around the nation are closely watching California, which has nearly 7 million uninsured and the highest number of people enrolled in new coverage of any state. In the first month of sign-ups, California consumers made up about one-third of the new enrollees nationwide. As of Nov. 19, nearly 80,000 Californians had signed up.
Kevin Horn, a 60-year-old self-employed graphic artist in Orange County, is among the more expected sort of enrollees: an older person with health problems. He takes about 18 pills each day, and many of his prescriptions will run out in January. He pays about $500 each month for insurance through a special program for people with preexisting illnesses. His new plan through Covered California will cost him $74 a month.
"I am definitely eager and anxious," Horn says.
Health advocates urge people not to draw too many conclusions from these early numbers; Californians still have more than four months in which to sign up.
"The first inning of a baseball game rarely tells you what the final score is going to be," says Anthony Wright, executive director of the consumer group Health Access.
This story is part of a partnership with Kaiser Health News, an editorially independent, nonprofit news service.