Health Care Home Stretch

Young Invincibles, the political advocacy group that has been helping students and other people under 35 enroll in health care programs under the Affordable Care Act before the March 31 deadline, has more than 100 events planned around the country Saturday as part of National Youth Enrollment Day. The events are, in part, an effort to make up some of the ground that was lost due to debilitating malfunctions on the federal enrollment website, HealthCare.gov.

So it's a little inconvenient, and more than a little ironic, that the website will be down for maintenance for much of Saturday and through 5 p.m. Tuesday, the last day to enroll for coverage by March 1.

"Obviously it's unfortunate," Aaron Smith, executive director of Young Invincibles, said Wednesday in a press call with reporters about the latest enrollment numbers. "But I think we'll be fine."

As the March 31 deadline for coverage in 2014 approaches (after which point the individual mandate tax penalty is enforced), advocates and opponents of the ACA, better known as Obamacare, are in the final drive to get students signed up or steered toward other, potentially more affordable options in the private market.

"We're still pushing the same message that we've been pushing from the beginning," said Corie Whalen, a spokesperson for Generation Opportunity, the economic advocacy group behind Creepy Uncle Sam, which portrays the health care law as intrusive government overreach. "The problem is that Obamacare simply doesn't make financial sense for young people. We just can't afford it relative to other priorities."

ACA enrollment is still lower than initially projected, but youth enrollment continues to accelerate. More young people age 18-34 enrolled in January than all other age groups combined, Health and Human Services Secretary Kathleen Sebelius announced Wednesday. Young adult enrollment grew by 65 percent in January, with 807,515 now enrolled. That's 25 percent of the 3.3 million people who have signed up since open enrollment began Oct. 1.

Yet last year, the White House said it expected 7 million people to be signed up by the end of March, 40 percent of whom would be young adults.

ACA advocates have speculated that more young people who procrastinated would be driven to sign up by the upcoming deadline, and that the HealthCare.gov glitches were a major turn-off for those who may have tried earlier.

"We live in a generation that has never experienced things like dial-up, and so a slow website is basically a non-functioning website," Linda Leu, Young Invincibles' California policy and research director, said in an interview.

Leu downplayed the significance of underenrollment of young adults, who are needed to subsidize the health costs of older people in the marketplace who are more likely to use their insurance. If young adults don't show up, the marketplace plans could end up costing more.

"Obviously we are interested in as many young people signing up as possible," she said, "but we don't see a problem with the system falling apart or the world ending or anything like that in the near future."

Some students have been harder to reach than others. Advocates and opponents of the ACA have been running educational programs and events on campuses across the country, but students at community colleges have proven most difficult to reach, Leu said. A group of special interest because they are more likely than students at four-year colleges to be over the age of 26, and thus ineligible for coverage under their parents' plans, community college students are at the same time less likely to be connected to health care or clinics through their institutions. (Many may be covered through their employers, though.)

The under-26 provision "is confusing the issue," said Bryan Liang, director of the San Diego Center for Patient Safety at the University of California at San Diego School of Medicine.

"In combination with the challenge of explaining the costs (the deductible to be met beyond premiums), it's been a hard sell generally," he said in an email.

"There's definitely still an awareness gap that we're working to address," Leu said, "but I think once young people find out what their options are, that they're going to find that it's affordable to them."

Others aren't so sure. One study last month, from the consumer price comparison site NerdWallet, said that young adults could end up spending five times as much on health care expenses under the ACA than they would if they were uninsured.

Making projections based on (now outdated) January enrollment data, the study said, the average uninsured young adult will pay $348 for heath care in 2014, as opposed to $1,717 under the ACA. A trip to the emergency room boosts those costs to $2,022 and $2,791, respectively.

For the students whose college-provided health plans are being dropped because of ACA provisions requiring that they comply with the same federal rules as other plans (for example, they can't discriminate based on pre-existing conditions), the difference in cost could be significant.

"We've been seeing that more than anything else, and it's disproportionately affecting minorities and students in low-income houses because their parents might not even be covered," Whalen said. "A lot of them have actually ended up uninsured -- which is a huge problem."