Affordable Care Act Attracting Younger, Healthier Insureds

By Danielle Burger | July 1, 2015

Obamacare is attracting younger and healthier people to its coverage plans this year, according to research by Express Scripts Holding Co., a trend that could help balance and sustain the law’s insurance markets.

According to the report, which looked at people enrolled in drug coverage administered by Express Scripts, drug costs were 36 percent lower than in 2014. People in the exchange plans were also younger by almost four years than those who signed up for 2014, Express Scripts said.

Insurance markets depend on a mix of people paying premiums to subsidize the medical costs of others when they fall ill. To be sustainable over time, Obamacare will have to attract enough healthy people to keep coverage affordable.

“It’s not quite a balanced picture yet, but it’s possible if the trend continues, it’ll become balanced,” Julie Huppert, vice president of health-care reform at Express Scripts, said in an interview. “We’ll watch over time to see if the behavior of new enrollees changes.”

Express Scripts’ drug plans cover more than a third of all people who bought insurance through the Patient Protection and Affordable Care Act, according to the company. Express Scripts administers pharmacy services for health insurers and companies, and negotiates coverage and discounts with drugmakers. It’s the U.S.’s biggest pharmacy benefit manager.

About 10 million people bought health insurance through the law for 2015, the second year for which coverage has been available. The Obama administration initially set a goal of having 40 percent of enrollees under 35 years old.

Getting Younger

About 28 percent of people who enrolled in an Express Scripts plan for the first time were 18 to 34 years old. They are, however, skewing younger — Express Scripts members in 2015 were 40.7 years old, on average, compared with 44.5 years old last year.

Part of the higher cost for exchange plan member may be because they’re getting health insurance for the first time, or have previously untreated conditions. In addition, people under 26 years old can stay on their parents’ health plans, instead of having to buy coverage on the exchanges.

While the number of people using expensive specialty medicines in the first quarter of this year fell 48 percent compared with a year ago, exchange members are still more likely to use high-cost drug categories. Compared with the rest of Express Scripts’ patients, almost twice as many people in the exchanges had drug costs of more than $50,000 a year during the first 15 months that people had coverage through the law.

Much of the spending is for diabetes, hepatitis C and HIV medications — those categories accounted for almost a third of Express Scripts members’ exchange plan drug spending.

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