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@ Karl and @ Elenore; the topic of this thread is that the "young invincibles", those young and healthy adults participation in the health insurance exchanges may determine whether the exchanges and the ACA are successful. If too many of the "young invincibles" decide to sit on the sidelines and not become insured; then that would cause a higher degree of adverse selection for health insurance policies purchased through the exchanges. In order for the insurance exchanges to work effectively and in order to gain greater control over the cost of health insurance, everyone must participate. That means the healthy as well as the sick and the young as well as the old. If too many young and healthy people decide that it better to remain uninsured rather than get health insurance, then it will skew the insured population.
IMHO, the penalties for not becoming insured are way too low. Those penalties are only $95 next year and increasing to $695 in 2017. Those are less than the annual cost of a health insurance policy, even with a premioum subsidy. I believe that one of the first things that congress needs to do is increase the penalties for not getting insured so it becomes more costly to not be insured than to purchase a health insurance policy through the exchanges.
I also said that how the health insurance exchanges are communicated will make a large difference as to how many people become insured through the exchanges, especially those young and healthy people. The sick and older people will seek out the coverage since they need it bad, but those who are healthy have no incentive to get insured right away.
In addition because young adults tend to have lower incomes than older adults, most may be eligible for Medicaid should the states go along with the Medicaid expansion since their incomes might meet the new eligibility standard. Also those young adults whose income is above the 138% of the federal poverty level will be eligible for a premium subsiidy so their cost of health insurance is no more than 8% of their adjusted gross income. Also the exchanges and Medicaid expansion will only affect those young adults who cannot be covered on their parent's health insurance any longer or do not get health insurance through their employer. So it is expected that very few young adults will have to pay the full premium for their health insurance. Their income has to exceed 400% of the FPL before they are ineligible for a premium subsidy.
But as I have stated, if severely red states refuse to cooperate with the ACA by not going along with the Medicaid expansion and by refusing to communicate the exchanges to their residents; many young adults in those states will not become insured through the exchanges. This could result in much higher premiums for health insurance purchased through the exchanges in those states as well as a much higher number and perventage of uninsured in those severely red states.
Karl, you just do not get it at all and Elanore, no matter how much money the HMOs make, their costs are all dependent on the amount of risk they are sharing and the overall health care costs in the region they serve. As I had said, New Jersey has some of he highest health care costs in the nation and that is reflected in premiums for HMOs and health insurance.