Exchange Demographics: What We Do, and Don't, Know About Enrollees

by Anthony Wilson, Editor

Topics: Health Care Reform, Exchanges

The Obama administration last week revealed new data on the demographics of enrollment in the Affordable Care Act's health insurance exchanges. The numbers were met with great fanfare because they showed several new things that we didn't know previously.

For example, we learned:

  • 46% of the more than eight million exchange enrollees were male and 54% were female;
  • The overwhelming majority of enrollees (65%) selected a silver plan;
  • 85% of enrollees received a federal subsidy to help them purchase coverage;
  • Of the nearly 3.8 million enrollees who self-identified their race/ethnicity, 62.9% were white, 16.7% were black and 10.7% were Latino; and
  • 28% of enrollees were between ages 18 and 34.

In the past week, analysts have had a chance to analyze the new numbers. In her report, Avalere Health Vice President Caroline Pearson estimates that the new demographic numbers mean:

  • Double-digit premium increases are likely in some markets in 2014; and
  • The age distribution is consistent regardless of bronze, silver and gold plans.

What We Still Don't Know

While the enrollment data offers a richer picture of exchange participants, there still are certain things that we still don't know. For example, we still don't have definitive data on how many exchange enrollees previously were uninsured. Of the 5.18 million people who applied for a subsidy, just 13% said they had coverage at the time of their application. However, the Obama administration has said that figure is not a solid indicator of insurance status. Further, the report detailing the new data says "estimates of the share of previously uninsured vary widely among surveys."

We also don't know anything about the health status of the enrollees.

Health policy observers have made a big deal out of how many enrollees actually are in the 18-34 age bracket, because those young adults can offset the cost of older and sicker enrollees. While it is a reasonable assumption that many young people are healthier than older U.S. residents, it's still an assumption. Further, a different assumption -- that the reason young people are signing up for insurance now are doing so because they really need the coverage -- could mean those young enrollees are more costly than expected.

However, we won't know anything about the health status of any enrollees for a while. That's in part? because exchange plans can no longer ask enrollees about any pre-existing conditions. As a result, the only way to determine the relative health of enrollees is to wait for claims to start rolling in. For a true measure of how the ACA is affecting premiums, it could be several years until insurers are sure about their rates by examining consistent claims data and the individual mandate has enough teeth to convince more people to sign up.

Bob Semro, a health policy analyst at the Bell Policy Center, notes that this situation creates a sort of Catch-22. "The whole point of these demographics numbers is determining the rates. It's kind of interesting, they're looking at the demographics to determine rates, and the rates determine whether those demographics were the right mix," he said in an interview with American Health Line.

Is Looking at the Initial Demographics Worth It?

We know the age and sex and background of many enrollees, but we don't yet know how those things will affect premiums. Is it a waste of time for analysts, like Pearson, to do a deep dive into enrollment data?

Semro says examining the demographics behind enrollment can still be a "productive enterprise." He notes, "They do give a good indication of where we're at. It's just that it might take a few years or more to get a large amount of data to give us an idea of how the law is working."