So much of the news the last few months has been dominated by the foibles of the Affordable Care Act.
Yet the truth of how good or bad various parts of this major piece of health reform are won't be known for a long time.
But I like the way the nonpartisan Kaiser Family Foundation has been looking at the provisions of the ACA and providing straightforward evaluations. During a webinar for journalists Dec. 17, two of the foundation's experts laid out their concerns for what we are likely to see going forward, especially as it relates to young adults.
You've probably heard that if not enough young folks sign up in the health care exchanges run by the federal government and the states, insurance premiums will rise catastrophically. The lack of participation might result in a "death spiral."
And what does that mean, you might ask?
We've been told that to make the risk pool less risky you need a significant number of healthy young people to sign up for insurance. That's why there has been a lot of focus on the group called the "young invincibles." If they don't enroll, the sicker people in the risk pool, who people expect will enroll in significant numbers, will drive up costs, and premiums. If that happens, healthy people in the pool may bail, driving up costs even more -- the spiral effect.
You need to also realize that things have changed in the way that insurance is priced because of the ACA. Premiums can no longer vary based on someone's health status or gender. Kaiser points out that under the ACA, premium variations based on age are limited to a ratio of 3-to-1. That means the premiums for a 64-year-old can only be three times the premium for a 21-year-old, Kaiser says. The pricing difference based on age was previously far greater -- typically five to one.