Friday, December 6, 2013

Ignore Those Polls!

The "Millenials" poll out earlier this week showing (among other things) younger people unenthusiastic about the ACA has sparked a fair amount of discussion, but there's one particular point I haven't seen made. I'm highly suspicious of the reported finding that only a third of the uninsured from ages 18 through 29 intend to enroll through the exchanges.

There are just too many things out there for me to believe that there's any kind of predictable relationship between what they tell a pollster and what they'll actually do.

Let's see...first of all, I'm pretty skeptical about asking the younger part of this cohort about personal intentions with regard to health insurance at all. Perhaps I find it hard to put myself in their shoes, since I was a full-time college student at that age and from a middle class family; I didn't have to think about health insurance at all until after graduation. At any rate, for those at ages 18 through 25, the survey asked what they would do "after you are no longer eligible to stay on your parents plan." As far as I can tell from the survey, that was used for everyone in that age range, regardless of whether they had insurance on a parent plan now.  If that's case, then I'd suggest it's totally meaningless what a 18 year old tells a pollster she expects to do about obtaining health insurance over five years into the future.

And then there's the question of what they're signing up for. The poll used a split sample to ask about both "Affordable Care Act" and "Obamacare," which is great. But there's no mention of Healthcare.gov in either case; instead, it refers to only "government-run exchanges." I'm really not confident that most young people know what that means -- or that they would need to in order to sign up. Then there's the issue of the state-run exchanges; people in Kentucky or California may believe that they're not signing up for "Obamacare" at all. It's also true, although again there's no way to know how it affects polling responses, that a fair number of uninsured young people will be eligible for expanded Medicaid. Would they say they are planning on using "government-run exchanges" or not? That's not even figuring out what to think about those who would be eligible for Medicaid but have the bad luck to be in Texas or some other state that didn't participate.

One more thing: even for those who are eligible for the exchanges now and understand what they are, it's still not clear how well what they tell pollsters of their intentions will match what they eventually do. Some may say they intend to sign up but then never get around to it, or start shopping and then decide it's a bad deal for them. Others may not intend to and then find out that subsidies make it a good deal.

My guess is that for most young people, at some point they'll confront the question of "how do I get health insurance?" for the first time -- in many cases, because a parent is nagging them about it -- and unless they have employment-linked coverage, the answer is going to be to go to Healthcare.gov or their state exchange. And, yeah, it won't really feel like signing up for Obamacare; it's just going to be how you get (private) health insurance.

Which, I should add, is not a prediction about how many will sign up and at what age, and how that will affect the overall pool (and thus the degree to which the ACA exchanges work or don't work).

At any rate, I don't think the poll tells us anything about what young people are going to do when they get to that point of seeking insurance. General point: be very suspicious any time people answer polling question about intentions they might not have had until they were asked. Ignore those polls!

15 comments:

  1. I'm suspicious of poll results that say that people would rather go uninsured than go through the exchanges or even explore their options. Sarah Kliff wrote a great reminder yesterday (and Zerlina Maxwell has made this point, too) that regardless of how badly Hearthcare.gov functions, being without insurance is even worse.

    Presumably, many of these young people had health insurance before, when they were children, and there is some expectation that they should see a doctor and dentist at least once a year. It's difficult to fathom choosing to do without insurance when affordable options are available.

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  2. Somewhat in reply to Kal above, I've been thinking a bit how different health insurance is from auto or homeowners insurance. Even though the actuarial probability of a significant auto or home-related expense is much less predictable than a significant health-related expense, auto and home insurers nevertheless go to much greater lengths to customize their policies on actuarial differences.

    Jonathan's correct of course that polls don't tell us how kids will behave. I can't recall the cite, but I remember reading recently that as many as 40% of employees voluntarily opt out of their companies' large group plans. In spite of significant employer subsidies, in spite of no alternative spousal large group plan, in spite of the hostility from HR. We don't need a poll to know that those 40% would be comprised of almost entirely young invincibles, do we?

    I'm a grump on this topic, but my fear is that we are collectively avoiding the moose on the table that will bite us badly in the arse. Kal's linked article from Sarah Kliff above is a great example; Kliff reports that the people who have tried to get on the health care website have been really committed. I'm sure that's true! Kliff went on to cite a couple examples, and in spite of the zeitgeist, didn't feel compelled to note the obvious: she clearly wasn't referring to young invincibles. (Pay no attention to the man behind the curtain...)

    Basically, the reason why Obamacare will succeed among young invincibles is that the actuarial disadvantage to them is offset by the protection on the smallish chance that their assumption of invincibility is wrong. By that logic, everyone should be willing to pay the same full boat price for their auto or homeowners insurance, shouldn't they?

    Leaves a question for those convinced that the young invincibles will willingly absorb the actuarial disadvantage in exchange for protection from an extreme health outcome: why do you think State Farm sacrices profit in exchange for the "Discount daaable-check"? Couldn't GEICO think of something better to do in those 15 minutes than saving low-risk consumers 15%?

    I want to be pro-Obamacare, and to Anastasios' point a while back, we're stuck with it...but seriously, assuming young healthies will willingly absorb their actuarial disadvantage runs pretty contrary to human behavior as we otherwise observe it.

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    1. If 40% of employees voluntarily opt out of their companies' large group plans, then it is almost certainly the case that the vast majority of them receive insurance through a spouse or parent. For some context, according to gallup, 44.5% of Americans receive insurance through their employers, and 25.6% through government programs generally only available to retirees and low income families that don't have access to affordable insurance through employers, like Medicare, Medicaid, and CHIP (http://www.gallup.com/poll/160676/fewer-americans-getting-health-insurance-employer.aspx). The combined 28% of uninsured and individual market insured is not nearly high enough for nearly 40% of American workers who are offered health insurance through their employers to be under-30's who think they're invincible and don't want health insurance. Heck, I'm doubtful there are even that many under-30's working, much less working at jobs that offer them insurance!

      Anyway, if the government mandated that auto insurance companies charge the same amount for everyone and then mandated that everyone buy insurance or face large fines, then we would all still have insurance. Even the young invincibles... who, incidentally, already face higher insurance rates today for auto insurance, yet still generally get their cars insured.

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  3. @CSH if you want to assert "that those 40% would be comprised of almost entirely young invincibles" you will need to provide the poll/survey/study that supports this claim.

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    1. Alas, as I said above, I can't recall the report of the stat, much less the source. Like any unsubstantiated, semi-anonymous claim on the tubes, you'll have to discount it appropriately and subject it primarily to your own common sense.

      If it matters, I do hope that I'm wrong about all this. Not just because, in Plain Blog world, "Wrong is the new Right" (though that's pretty cool), but mostly because if I am wrong that will be all for the best.

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    2. Discounting it appropriately would mean discounting your position on the matter completely.

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  4. JB,

    Have you considered getting into polling? You seem dead convinced that you could do it better than the people who already do.

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    1. Maybe you should consider getting into professional heckling, as that's all you seem to do around here.

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    2. If you've specialized in any industry, you know that a lot of laypeople believe that they have something figured out that could really improve your industry. They're almost always really wrong. JB consistently whines about polling questions, but never posts about how he spoke to X from Y polling company who was dazzled by his ideas. My guess: the polling experts have good reasons to word their polls as they do and JB is being painfully ignorant. Until he explains his interactions with them, it's best to view these posts of his as Top 10 List whinging from the comment section.

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    3. @backyard, I hope there was irony in your use of "Top 10 List whinging." JB whinges with much, much firmer standing than you do.

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  5. I'm a Millenial who now has affordable health insurance thanks to the ACA. I could not go on my parents' plan, as they live in a country with actual universal healthcare, and couldn't get insurance through an employer as I am self-employed.

    The thing is, I wouldn't have even bothered with any of it if I hadn't had an accident that landed me in the hospital for almost two weeks while I was in college. The hospital bill was larger than all the money I had earned up to that point in my life. I was financially ruined before I was even able to start a career.

    That was a lesson learned, and in my case it showed me the value of health insurance. That being said, most everyone I know could care less about getting insurance, because they've mostly never had to deal with a medical emergency like I did. Obamacare or healthcare.gov are absolutely the last things on their minds, and, as you said, they probably won't sign up for anything unless their parents nag them. I know anecdotal evidence is worth pretty much nothing, but most people I know who are my age would rather just pay the penalty and not bother with getting health insurance that will end up costing more in the long run.

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  6. Honestly, I don't expect many folks to sign up this year. The whole concept of the ACA is built on the individual mandate; it's the only way the goodies get paid for. That mandate is enforced by the IRS.....in April. The self-employed don't have HR to remind them to sign up. Those without insurance had not yet chosen to buy some, whether because of CSH's logic or because of Anonymous @1:04's. They need SOMETHING to push them into it; I really and truly doubt Cooper's #2 as just plain denialist fantasy. (Similarly, nothing about #1, 5, or 6 changed either the day ACA passed or on 1/1/14).

    No, people will sign up when the IRS makes them or they find out from friends or whatever that there are subsidies and health care is now somewhat affordable.

    This is why the conservative push to delegitimize it are so important. If conservatives can make it seem like the coverage sucks or it's too expensive, then nothing will have changed in the lives of the uninsured, so why would they change their behavior? (They're completely barking up the wrong tree with the creepy Uncle Sam tactics of "it's bad for you/takes away your freedom": they're taking the sermon meant for the choir and trying to ply that in the town square)

    Young folks will sign up when either convinced to or forced to. That will take a while, and that lag may end up really killing Obamacare. Until they sign up, Obamacare is all goodies (coverage, pre-existing, etc.) with no way to pay for it. I'm not crying for insurance companies (they do fine without my help), but if people don't start showing up in a couple of years, it's bad.

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    1. Mostly, this is just one where we'll wait and see what happens, so I guess arguing it is a bit pointless. Still...insurance companies aren't exactly without advertising resources, and neither is the federal government.

      My basic feeling is by age 30 or so, most people, including healthy people, would like to have health insurance. Sure, some won't get around to it, but lots of people tried and failed in the bad old days, and they'll try and succeed (mostly) now.

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    2. HR isn't gong to remind you -- we don't care. The IRS will remind you -- they are the ones assessing the penalties. HR falls under their company mandates with respect to the number of full time employees. They will take care of you under their company mandates period. Heathcare.gov is more of an entitlement program management system -- why buy from a government program when if you are not receiving a subsidy and can afford your own heathcare -- go to the open market better deals and way more options.

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  7. It seems to me there are ways to make health insurance more attractive to younger people, like some kind of discount applied to federal student loans. If one house of Congress wasn't controlled by a party with no interest in the health of American citizens or of the American economy, such possibilities could be entertained.

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