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Exchanges could skew young

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The new public exchanges could have trouble with attracting young people — or trouble with meeting the health insurance needs of older consumers.

Steve Zaleznick, a marketing strategist at, and Richard Hamer, a market analyst at Deft Research, suggest getting older uninsured consumers into the exchange system could be tougher than most expect.

The market researchers make that argument in a paper based on hypothetical coverage price data and a survey of 5,084 uninsured U.S. consumers ages 18 to 64.

When the analysts classified the consumers as most, least or moderately likely to buy health coverage in 2014, they found consumers ages 19 to 34 made up 37 percent of the likely buyer pool and only 28 percent of the least likely buyer pool.

Consumers 50 to 64 made up 35 percent of the most likely buyer pool and 44 percent of the least likely buyer pool.

“Many older uninsured persons will find even their subsidized premiums to be too expensive,” the analysts said.

The Patient Protection and Affordable Care Act is about to require carriers to sell individual coverage on a guaranteed-issue basis and while limiting them to charging the oldest adult customers only three times as much as they charge the youngest adult customers.

Today, in some states, carriers sell little coverage to older consumers. The oldest pay rates five times as high as what the youngest pay.

Supporters of the new system — and some critics — say it will help lower the net cost of coverage for many older, sicker insureds while increasing costs for younger, healthier ones.

But PPACA also tries to encourage people to buy coverage by offering a new health insurance purchase subsidy for people with “modified adjusted gross income” of 133 percent to 400 percent of the federal poverty level.

People who earn more than 400 percent of poverty level will get no subsidy.

For a 60-year-old couple, for example, the net cost of coverage might be just $6,000 per year if annual household income is $62,000 per year, and $16,000 if household income is $63,000 per year.

Consumers at higher income levels also will have to be aware of the risk that they might have to pay back any excess subsidies received, Zaleznick and Hamer said.

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