More young, high-income men have coverage under the ACA despite predictions they would flee the market

Changes to insurance regulations under the Affordable Care Act (ACA) were supposed to drive young, healthy men with higher incomes from the insurance market.

But according to a study published earlier this month, that didn’t happen. In fact, uninsured rates dropped significantly among young, healthy men during the first few years of ACA implementation.

That’s according to research by the Commonwealth Fund, which found that the uninsured rate among men 26-34 with incomes above 400% of the federal poverty level dropped from 11.7% in 2013 to 7.2% in 2015. Comparatively, uninsured men 55-64 dropped just 1.4 points from 3.9% to 2.5% over the same period.

“The ACA’s mandate increased both the incentive for having insurance and the importance of the decision,” researchers with New York University’s Robert F. Wagner Graduate School of Public Service wrote. “This combination greatly increased coverage among young men.”

It’s a notable coverage boost considering the ACA’s new rules increased premiums for healthy young men that didn’t qualify for federal subsidies. Prior to the regulation changes, young women paid disproportionately more than young men, and older men often paid nearly five times as much for health insurance coverage.

The ACA prohibited insurers from varying premiums based on gender and limited premiums for older adults to three times that of a 21-year-old with the same coverage. While those regulations eased the burden for previously disadvantaged populations, it meant young, healthy men that didn’t qualify for subsidies would bear the brunt of higher costs.

Some states already imposed rating rules for insurance coverage, easing the impact of ACA regulations. However, researchers found that the percentage of uninsured young men that didn’t qualify for subsidies declined at nearly the same rate in states that didn’t previously have rating rules as in those that did.

The authors credited a mix of financial penalties plus a marketing blitz that accompanied the ACA’s rollout. The study raises new questions about how new policies could impact coverage. The GOP’s tax bill repealed the individual mandate, a change health insurers say will lead to higher premiums.

Last year, the Trump administration slashed its ACA marketing budget from $100 million to just $10 million.

“After the ACA’s implementation, the increase in nongroup coverage and the fall in the percentage of uninsured young men likely were caused by the new financial penalties and the increased significance of coverage generated by the individual mandate and marketing efforts to promote the ACA,” the researchers wrote.