6 big unanswered questions about Obamacare

6 big unanswered questions about Obamacare

1. How many people have actually enrolled? This is the big one. I’ve written about it a lot for a reason: The headline sign-up numbers are often described as enrollment numbers. They’re not. A significant portion of people who sign up for coverage aren’t paying their first month’s premium, and are therefore never enrolled. In California, it’sabout 15 percent of sign-ups. In Wisconsin and Georgia, it’s closer to 20 percent. In Nevada and Vermont, it’s more than 30 percent. Until we know how many people have paid, we won’t know how many people got covered.

2. What percentage of those who are enrolled are between the ages of 18 and 34?After the launch of the exchanges last October, the White House repeatedly emphasized that they were less focused on the total number of enrollments and more concerned with the demographic mix—specifically, the number of young adults signing up. Young adults tend to be less expensive to insure, so their premiums are needed to balance out the costs of the older, more expensive enrollees. Early on the administration had been clear that it was aiming for 40 percent of enrollees to be in the youngest cohort. But so far, the administration’s reports have indicated that only about 25 percent of sign-ups are young adults.

3. Are the young people who are enrolling actually healthy? This one will be hard to answer, but it’s important. In the population as a whole, young adults tend to be healthier, and therefore less inclined to use lots of health care services, than their elders. But the characteristics of the 6 million or so folks who end up in the exchange population may not mirror the population as a whole. It’s entirely possible that the young adults who do end up signing up will be sicker, on average, than their peers. If so, that will complicate premium pricing down the road.

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