Will the young and fit jump in? Source: Pool Corp. via Bloomberg
Will the young and fit jump in? Source: Pool Corp. via Bloomberg

Last week, we saw that enrollment through the state exchanges has been heavily weighted toward Medicaid patients. This week, the Wall Street Journal reports that it is also heavily biased toward the old:

The average enrollee age at Priority Health, a Michigan insurer, has ticked up to age 51 for newcomers, from about 41 years old for plans offered for the current year, said Joan Budden, chief marketing officer. Arise Health Plan, Wisconsin's largest nonprofit insurer, said more than half its 150 signees are over 50, a higher proportion than expected, while declining to be specific on its target age….

In states that are running their own marketplaces and have seen smoother rollouts, officials are now also reporting a similar phenomenon, suggesting the economics of the law play a role, too. In Connecticut and Kentucky, which have enrolled more than 4,000 people each in private health plans so far, the largest segments of enrollees in new commercial health-law plans are over age 55, much older than industry actuaries say they had anticipated. Each state ultimately expects to register several hundred thousand people in their exchanges.

Age expectations for enrollees vary by market, but one adviser and several insurers said an average age of around 40 would be a typical target.

The more difficult it is for a person to sign up, "the more danger there is of having a bad risk pool," said Jim Whisler, an actuary for Deloitte Consulting LLP, which advises health plans participating in the marketplaces. "Indications to date are that that is playing out," he said.

The big worry with the exchange malfunctions was that this would cause adverse selection -- the very sick would persevere, while the healthy would give up. The resulting skew in the insurance pool could touch off a “death spiral” where the prices keep going up, the healthiest remaining customers keep dropping out, and you end up with a very sick pool of patients paying a fortune for insurance.

But it’s a little early to start diagnosing those kinds of problems. Even without the difficulties on the exchanges, you’d expect to see the oldest and sickest and poorest patients registering early. Those are the people for whom health-care expenses loom largest in the budget, so naturally, they are the most motivated to buy insurance.

Understanding Health Insurance Exchanges

What we want to know is what this pool will look like on Dec. 15. That’s not that far away. But hopefully, it’s far enough to sign up a lot more patients under the age of 50.