Obamacare: Sign-ups of healthy young people still lagging

With days to go before January coverage kicks in under California's health insurance exchange, Covered California, the numbers of healthy young adults signing up for coverage are still lagging, according to health-care economists.

It's widely known that adults aged 18 to 34 — who in the context of the new health law have come to be known as "young invincibles" because of their self-perception as being immune to sickness and injury —  could make or break the effort to keep costs for coverage low.

About 40 percent of the state’s uninsured are "young invincibles." Because the Affordable Care Act caps rates, the health exchanges need them to sign up in that same proportion to offset the costs for care of older, sicker people, according to Glenn Melnick, a health economist at the University of Southern California.

RELATED: Covered California 'grace period' for health insurance ends Friday (updated)

But Covered California's data show that, as of November — the latest month available — fewer than 22 percent of enrollees were between the ages of 18 and 34.

Jorge Ramirez, 33, exemplifies one reason why enrollment among young people may be low.

“If my choices are to pay $1,000 a year for insurance, or a $95 fine, I’ll just pay the fine,”  said Ramirez, who lives in South Los Angeles. He’s never bought insurance because he rarely gets sick.

Jen Mishory, deputy director of the nonprofit Young Invincibles, which is encouraging young people to buy insurance, said Ramirez doesn't speak for the majority.

“For the most part, this is a generation that does value coverage," she said. "It’s really a matter of cost, and walking through and thinking through how much you can afford and what makes sense."

Indeed, the low enrollment numbers by young people so far don’t seem to reflect their full potential. A recent survey by the Public Policy Institute of California found that 72 percent of people between the ages of 18 and 44 said they would get insurance, compared to just of half of people 45 or older.

“Pretty much every friend that I know who doesn’t have health insurance is signing up for it,” said Aaron Lee Dowell, 29. He hasn't signed up yet himself, but plans to, in part so he can play basketball all-out and not worry about it.

Trying hard to win

“I don’t like not being as competitive as I can, so I try as hard as I can to win,” he said. “And, yeah, occasionally I get hurt. You get hit, you get banged up. I fall.”

Dowell said he’s been looking forward to coverage under the Affordable Care Act for years.

December has seen a huge surge in people signing up overall, and officials hope the next batch of statistics will show a large proportion of them to be young people. Open enrollment continues through March 31.

Even if the numbers don't rise, that may not immediately mean higher premiums. Under the health law, the federal government will cover a portion of insurance companies’ losses for a few years. 

But it won’t cover all the losses. So Melnick of USC said a few things could happen if enrollment for young adults doesn’t pick up.

“Some of the plans, if they’re incurring a loss, may choose to drop out of the market,” he said. That would limit consumers' choices for coverage.

Another possibility, Melnick said, is that companies could raise premiums to make up the gap.

But that, he said, “could trigger more Young Invincibles dropping out of the system” as they begin to figure they’re paying more into it than they’re getting out of it. And that could start a vicious cycle that drives insurance costs higher and higher, undermining the entire health law.