by Barbara Morales Burke
There’s no denying that the rollout of the Affordable Care Act (ACA) and the launch of healthcare.gov were rocky. But North Carolinians did take advantage of their new ability to purchase health insurance. While we rank as the tenth largest state in population, we rank fifth in overall enrollment nationally.
As of May 1, 2014, we enrolled more than 232,000 customers in ACA plans through the Exchange. More North Carolinians having access to health insurance is a good thing. But the top-line enrollment number doesn’t tell the whole story.
First, let’s all remember how insurance works. Regardless of whether we’re talking about homeowners insurance, car insurance or health insurance, it is important to have a mix of customers. Health insurance is based on the assumption that more customers will use their health insurance only occasionally or for routine (often less expensive) services than for major health events or chronic conditions.
The goal is to find a good balance and have a mix of high users and low users.
As we prepared for the ACA, we anticipated 50% of our new ACA customers would be younger than 35. This would have given us the balance we needed. Unfortunately, only 32% of the customers we enrolled are younger than 35.*
To compound the problem, we’ve learned our customers who did enroll – including the young ones – are actually less healthy than our typical customers. In self-reported data, these new, younger customers are reporting a higher percentage of chronic conditions including diabetes, depression and asthma. We know from experience that customers with conditions such as these cost six times more than enrollees of similar ages without chronic conditions.
So where are all the young people?
We know that many stayed on their old pre-ACA plans when given the option. Or they just didn’t purchase health insurance at all. Our pre-ACA book of business included kids with child-only policies, and many of them were among those who stayed on their pre-ACA plans – which affected the age distribution of our ACA pool.
There are still a lot of unknowns. More changes could come from Washington. We will have to watch and see how our new customers use their new insurance, as well as how many end up dropping coverage during the year – and why they drop. But we know enough today to be concerned about the impact of our ACA customer pool on premiums for future years.
Check out a full snapshot of BCBSNC’s enrollment data for 2013-2014 in the infographic below.* (click to enlarge)
*Data represents Exchange enrollments only through May 1, 2014.