Obamacare in Delaware: Fewer young adults sign up

• 202%2C322%3A Number of millenials in Delaware %u2013 one-fifth of total population
• 23 percent%3A Delaware%27s rate of Obamacare sign-ups - the second lowest in the nation
• 28 percent%3A National average rate of sign-ups

Delaware millennials say it's important to have health care, but for some it's just too expensive.

Those 18 to 34 years of age are dubbed "young invincibles" because of the perception they are most likely to go without health insurance. According to the most recent census, that age bracket totals 202,322 Delaware residents, or a fifth of the state population.

Experts say having young, healthy people enrolled in coverage helps keep the price of insurance plans down, and in the wake of Affordable Care Act reform, the medical industry has meticulously monitored that population's health care decisions.

The law has provided options for them to get coverage, from expanding Medicaid and letting young people stay on parents' insurance until they are 26 to opening up a subsidized federal Obamacare marketplace.

The White House estimates 16 million people have gained health insurance coverage as a result of the system laid out in the Affordable Care Act signed five years ago.

But Delaware's rate of millennial Obamacare sign-ups, at 23 percent, is among the lowest in the nation and 5 percentage points below the national average. The only state with fewer enrollees is West Virginia.

Health officials at this point can only speculate as why the numbers are lower than other states. Without an increase, it's possible that insurance options will get more expensive, causing people to drop health plans or put off getting the care they need – the opposite intent of the Affordable Care Act.

"I'm hesitant to think that the outreach isn't there. ... I'm curious as to what does that represent. Why does Delaware look different?" said Delaware Health and Social Services Secretary Rita Landgraf.

Medicaid enrollment, now that the state has expanded the service to people within 138 percent of the federal poverty level, may contribute to the less-than-average sign-ups, Landgraf said. For the month of March, the state had 4,547 new Medicaid enrollees age 19-34. That's about 46.6 percent of the 9,751 newly eligible adults enrolled and on par with the numbers the state saw last year.

Landgraf said she is not fully satisfied with that enrollment, since that could mean more young people may be living in poverty. A single person on Medicaid has to make only $16,100 a year to be covered.

Kip Piper, a Washington, D.C.-based health care consultant and former senior adviser to the Centers for Medicare and Medicaid Services, said there's no need to sound the alarm at this point, although it's concerning that Delaware's young invincibles haven't bought into the system.

"We want people to have insurance whether its health insurance or car insurance," Piper said.

Twenty-three-year-old Nichole Bailey, an accelerated nursing student at the University of Delaware, said she supports buying into the system to help people who are less fortunate, but insurance needs to be more affordable. Being under 26, she is still covered under her parents' insurance, but their health plan prices have skyrocketed in the wake of ACA. Her parents, who own a small automobile business, pay about $2,600 a month for four people, she said.

To get by, they schedule appointments and well doctor visits around meeting their deductible and regularly have to fight to get services only partly covered. Bailey, who has a bachelor's degree from the University of Central Florida, said she had thought about pursuing medical school in addition to her secondary nursing bachelor's degree from UD, but not knowing where to get health insurance once she turned 27 deterred her plans.

"You're planning your whole life around your crappy health insurance ... I understand why it's high, but it is ridiculous," she said.

Fellow nursing student Tallie Coller, 27, also feels strapped by high health costs. Coller, a single mom, is enrolled in the University of Delaware's student health plan, which costs $1,115 for the year, on top of her per credit costs. Under the ACA, everyone must have health insurance, including students, or face a fine.

Full-time students at Delaware State University also have a student health plan, with an annual cost of $1,102, as does Goldey-Beacom College in Pike Creek.

Wesley College, a private institution in Dover with 2,500 students, discontinued its student health plan last April. Before the Affordable Care Act, the school's policy cost $145 per student. But now that health plans need to include more benefits and services, they typically cost upwards of $1,000. It's estimated it would have cost Wesley $1.4 million to support just the health plans.

Many students can opt out of their school's health plans because they are on their parents' insurance, but Jessica Reed, who oversees UD's health plans through their Office of Risk Management, said that many parents say the student plan is less expensive than their family plan and offers more benefits. The deductible, for instance, is $50.

About 3,000 full-time undergraduate and graduate students are enrolled this school year, a 30-percent increase from last year. Though some colleges are considering potentially eliminating the student health plan due to the increase in plan costs, UD will not be going that route, Reed said.

"Right now, it's a really big benefit to our students so I don't foresee us taking it away," she said.

Sally Pollard, director of operations for Silverside Medical Aid Unit, an urgent care facility in Wilmington, said that insurance companies are encouraging their clients to not go to the emergency department for minor illnesses.

"They are actually advertising for us as urgent care centers," Pollard said.

As a result, she's seen an increase in patients in general, not just millennials, by about 20 percent. Treatment for say a sore throat, she said would cost four to five times more if a person went to the ER.

"When you are there for a sore throat you are wasting resources," she said.

Most of the young people who come to Silverside for medical help say that the cost of insurance is too much and they'd rather pay the penalty, Pollard said. Since the ACA mandates everyone has health insurance, people are fined if they go without it.

The penalties for not having health insurance in 2014 are $95 per person and $47.50 per child, or 1 percent of the person's annual income, whichever is higher. Next year the penalties will be $325 per person or 2 percent of annual income.

A basic physician visit at Silverside costs $105, for example, and a non-narcotic prescription refill costs $60, which is more affordable for some than a monthly premium, Pollard said.

"Maybe they come here once a year. They say they'd rather pay that, then pay penalty than pay for the insurance on the monthly basis," she said. "And we do have a shortage of primary care doctors in this state ... we are just filling the gap."

Priscilla Chatman, an outreach coordinator for the Obamacare marketplace in Delaware, says that work still needs to be done to help young people understand that healthcare can be affordable.

"It is indeed a challenge reaching that population and getting them to internalize it that they need it," she said. "I don't understand how people buy a phone for $500 when you make $15,000 a year."

Ramped up social media efforts are needed, coupled with more partnerships with local celebrities.

Piper said the Affordable Care Act has changed the game dramatically by leveling the playing field so that insurance companies could not charge different premiums based on health status, age or gender. Previously, it was possible that a person 60 years old could have a premium up to six times higher than someone who was 20, he added. And women had higher healthcare costs because of additional maternal and childbirth coverage such as invitro-fertilization.

Now, under the Affordable Care Act the premise is everybody in the insurance pool is treated the same. Insurers can only charge three times based on age and health status and everyone has to share the costs. For example, a single male's health plan has to be enough money to cover the cost of pregnancy visits and children's services.

"Healthy people are subsidizing sick people. Men are subsidizing women and adults without children are subsidizing families without children," Piper said. "You have this musical chairs of dollars with the belief that once it's all done, when the music stops and everybody's in, you have to have enough healthy young people to pay for the older less healthy people."

The subsidies offered through the Obamacare marketplace are a major incentive to get young people to enroll in coverage, he said, but they may be taken away.

In June, the U.S. Supreme Court will take up a case that questions a statute in the Affordable Care Act that describes who is eligible for government subsidies, throwing 8 million people, including 21,000 Delawareans, back into health insurance limbo.

Out of the 25,036 Obamacare sign-ups, 84 percent were eligible for government subsidies to help pay for part of their monthly premiums. The average subsidy is about $264 per month. The state does not have information on how many Delawareans 18-34 receive subsidies.

In the King v. Burwell case, the plaintiffs filing against U.S Department of Health and Human Services Secretary Sylvia Burwell say that subsidies offered to everyone who purchases a marketplace plan are illegal. If the subsidies were not available, they would not pay a penalty for failing to be insured because even the cheapest health plan would be too costly. They object that health insurance should be mandated for all.

If the plaintiffs win, states would need to scramble to form a contingency plan so that Delawareans who receive subsidies would be able to still afford their health plans. Or else, they would need to drop them.

The perceived cost of health plans is already one of the biggest barriers to getting young people to enroll in coverage, said Erin Hemlin, healthcare campaign director for Young Invincibles, a national non-profit that works to engage young adults on issues, such as higher education, health care, and jobs.

"We are definitely watching it pretty closely," Hemlin said. "I think the financial help is absolutely crucial in order for young people to have plans. Clearly people want health insurance but they need it for it to be affordable. We are just concerned that young people know what their options are and have access to coverage."

Jen Rini can be reached at (302) 324-2386 or jrini@delawareonline.com. Follow @JenRini on Twitter.

BY THE NUMBERS

202,322: Number of millenials in Delaware – one-fifth of total population

23 percent: Delaware's rate of Obamacare sign-ups - the second lowest in the nation

28 percent: National average rate of sign-ups