Caroline Pearson at Avalere has a piece on how the House of Representatives AHAC healthcare program penalizes older and lower income people more so than higher incomes and younger people. Just to refresh your memory, the ACA penalizes people who do not have insurance based upon income.
While the penalties under the ACA are based upon income, the penalties under the AHCA are based upon age determinant premiums. Older people under the AHCA have higher premiums up to 5:1 of the younger insured rather than the 3:1 ratio under the ACA. Remember too, the ACA does not use age as a determinant of the size of penalty which is based upon income. While most likely the healthiest, many Millenials have lower incomes and could an have issues paying the penalty under the AHCA as the size of the penalty at lower income is a larger percentage of annual income. The impact of large groups of the younger and healthier Millenials not buying insurance could be felt in the risk pool potentially forcing higher premiums for everyone. Different than the penalty being paid to the government under the ACA, the penalty under the AHCA is paid to a private company. It will be interesting to see if this is be tested in court also
If young adults are discouraged by the penalty and cannot afford to enroll, it could hurt the risk pool. While a recent RAND analysis showed that young people as a whole moving in or out of coverage may not have a large impact on the risk pool, the healthiest and least expensive young adults not enrolling could still result in a significant negative impact on the pool. A recent CBO report confirms a similar projection of those deterred from enrolling due to the continuous coverage provision will tend to be healthier and a penalty could have a significant negative impact on the risk pool and result in higher premiums. Certainly the size of the penalty regardless of income will have an impact as well as the age/premium factor.