There will be a bit of a youth movement during this fall’s enrollment period for the Affordable Care Act (ACA).
White House officials have announced a strategy that targets adults under 35 in an effort to increase sign-ups for the ACA health insurance plans when the enrollment window opens Nov. 1.
Under the new strategy, Obamacare officials will reach out via email to young people who paid a penalty on their 2015 taxes for being uninsured, as well as people who are turning 26 and are no longer eligible for their parents’ insurance plans.
The campaign is launching as predictions are coming in that insurance premiums will rise more dramatically next year, a statistic that could deter younger people from signing up.
However, it also comes amid speculation that so-called “red states” that have blocked the expansion of Medicaid programs will back down next year and allow more enrollees into that federally funded low-income healthcare plan.
The push to get enrollment
ACA officials say 45 percent of people who paid a tax penalty, or claimed an exemption to Obamacare rules last year, were under the age of 35.
The officials will use Internal Revenue Service (IRS) records to locate these individuals.
ACA officials will use other government data to target adults who are turning 26 and leaving their parents’ plans.
All these younger adults will receive a targeted email with specific instructions on how to enroll.
“We’ve learned that sending an email, with the right information, at just the right time, can make a significant difference in whether someone gets covered,” ACA officials said in their strategy announcement.
Enrollees will be able to start the enrollment process and then pick it up where they left off if they need to stop and come back.
ACA officials are also partnering with 75 other groups to coordinate four targeted campaigns. Those efforts will be the focus of a National Millennial Health Summit on Sept. 27.
They also are working with the American Hospital Association to develop a social media tool kit for hospitals to use to reach young adults.
In addition, the ride service Lyft will introduce user discount codes for people attending ACA open enrollment events.
The reasons for the youth push are simple.
Younger adults represent the biggest pool of prospective uninsured applicants. Only about 28 percent of the nearly 13 million who signed up in ACA marketplaces last year were between the ages of 18 and 34, according to a Kaiser Health News report.
In addition, these healthy enrollees are needed to help balance out the insurance participants who require more healthcare services.
Kurt Mosley, vice president of strategic alliances for Merritt Hawkins health consultants, said he likes the White House strategy because it’s direct and it’s a step-by-step approach.
“People need to understand that if they are not insured, they’re part of the problem,” Mosley told Healthline.
Gerald Kominski, Ph.D., director of the University of California, Los Angeles, Center for Health Policy Research, noted this strategy is similar to the one used during President Obama’s election campaigns in 2008 and 2012.
“It’s very effective microtargeting,” Kominski told Healthline. “It’s a pretty good strategy.”
Obstacles lie ahead
Despite the strategy, both Mosley and Kominski expect sign-ups in the upcoming ACA enrollment period, which runs from Nov. 1 to Jan. 31, to be flat.
There are several reasons for this belief.
One reason, both experts said, is the tax penalties for being uninsured aren’t high enough.
That penalty is rising for the 2016 tax year to 2.5 percent of total household income, or $695 per adult and $347 per child, to a maximum of $2,085.
Kominski and Mosley say the penalty is less than most people would pay in insurance premiums for a year.
In addition, if those uninsured individuals develop a serious health problem, they can enroll during the following sign-up period because insurance companies can’t deny coverage for pre-existing conditions.
“A higher penalty could drive people into the market,” said Kominski.
Another factor is the expected rise in insurance premiums in 2017.
A study by the Kaiser Family Foundation predicted that premiums on the popular second-lowest silver plans would rise an average of 10 percent in 14 major metropolitan areas. Premiums this past year on those plans jumped an average of 5 percent.
The report does note that those premium hikes won’t affect 80 percent of marketplace enrollees because a government subsidy will cover them.
Nonetheless, both experts said the predictions of higher premiums could discourage some people from signing up.
“It has a dampening effect,” said Kominski.
Mosley said premiums are expected to go up, in part, because there will be fewer insurance companies in the ACA marketplaces.
One reason for that is the number of people with pre-existing conditions who signed on to ACA plans.
“All these pre-existing conditions shocked people,” said Mosley. “These pre-existing conditions are expensive.”
The ACA marketplaces are a relatively small part of the overall health insurance market.
About 150 million Americans get health insurance through their employer. Medicare and Medicaid cover another 100 million, according to the Kaiser Family Foundation report.
Nonetheless, the nearly 13 million people on ACA plans, and the 5 million enrolled under expanded state-run Medicaid programs, are important.
That’s because people who are uninsured can significantly increase healthcare costs across the country. People without insurance generally don’t seek preventative healthcare and many times end up in emergency rooms with more serious conditions.
“Insured people are less costly than uninsured people. It’s that simple,” said Mosley.
Both experts said the best chance to increase ACA marketplace enrollees is through the expanded Medicaid programs.
Until recently, 20 states had elected not to expand their Medicaid programs.
That changed earlier this year when Louisiana decided to join the ranks of the states that offer the expanded Medicaid option. That program begins there on July 1.
Mosley and Kominski said the reason was simply because all those uninsured people were a burden on the state healthcare budget.
“The cost is astronomical,” said Mosley.
Both experts said other holdout states would probably wait until the November presidential election before deciding what to do.
Republican Donald Trump has promised to dismantle Obamacare. If he wins, the holdout states don’t have to change.
If Democrat Hillary Clinton wins, then the ACA program will continue, and those states will probably decide to capitulate.
“At some point, you have to surrender,” said Kominski.
Overall, Mosley said he would encourage the White House to expand its educational campaign, and also bolster recruitment for minority enrollment.
Kominski said a national advertising campaign for ACA enrollment should be launched, although he would wait until after the election.
“A bolder national advertising campaign might elevate the awareness,” he said.