Though replete with delays, exceptions, confusing decisions, and perverse incentives, the implementation of the Patient Protection and Affordable Care Act (PPACA) continues to move forward.
The Administration is reporting this week that enrollees on the state and federal health exchanges have so far fallen short of initial projections, though December enrollments showed a significant improvement over the first two months of the troubled launch. Open enrollment in the exchanges for individuals runs until March 31, 2014.
Potentially more troubling than the total number of enrollees is the relatively low proportion—thus far—of younger adults who make up this covered pool. One of the primary concerns about PPACA implementation has been whether sufficient numbers of younger, healthier Americans would sign-up for coverage. Without the participation of this key demographic, premiums could spike for the rest of the pool. So far, the Administration reports that only 24 percent of the new enrollees have been in the 18-34 age group, despite making up 40 percent of the total eligible pool. Nevertheless, the Administration continues to express confidence that the share of younger adults will rise as the March 31 deadline approaches; they reason that older, sicker individuals are more likely to sign-up sooner, while younger, healthier individuals are more likely to put of the purchase until close to the deadline.
Another component of the health care law kicked-in on January 1: the Health Insurance Tax (HIT). This is ostensibly a tax on health insurers, but the tax will inevitably be passed on in higher small business premiums. NSBA has strongly urged repeal of the HIT, as it will only exacerbate the premium rate increases already expected by most small businesses over the next year.