At the heart of the health overhaul law is a fundamental shift in the way health insurance is priced: the same rates for everyone regardless of their health, with limited variation based on age, and a set package of benefits. That change creates winners and losers. In Portland, Ore., we found two-dozen “young invincibles” without employer-sponsored insurance and whose participation in the new individual markets is key to the success of the law. Through an exclusive analysis of insurance industry data, we showed them exactly what their coverage would cost and how much would be subsidized by the federal government. Their reactions revealed just how difficult it would be to get many of them to sign up in the early years of the law. In Toledo, Ohio, we found older workers with low wages and no health benefits, crunched their coverage costs and found they stood to gain significantly from the new insurance pricing and tax credits. The contrast revealed a major challenge ahead for the law since it relies on young, healthy people buying insurance to offset the cost of riskier enrollees.
