Even with a 3 to 1 ratio, older people will pay a lot more in absolute dollars than younger people. A few years ago I shopped The Connector, the exchange in Massachusetts that was a model for Obamacare, and which allowed a 2 to 1 ratio between what older people can be charged vs. young people. There I found that a 54-year old couple in Pittsfield would spend $2,252 per month for a premium HMO from Blue Cross Blue Shield, while a 34-year-old couple there would pay $1,649. Differences even higher than these will be apparent in all states next year, when the 3-1 ratio takes effect.

And you can imagine the differences with a 5-1 ratio. Young people often don’t have a lot of money. But what is less appreciated is that old people often don’t either.

That’s part of the rate story too, but one AHIP has so far not chosen to tell. When older people find they can’t afford high premiums, they also might decide not to buy insurance. Will that be a good or a bad thing for insurers? Or for the healthcare system overall? Or for Americans young now who will be old later? Reporters need to raise those questions, too, and they shouldn’t wait for wait for AHIP to tell them the answers.


The Second Opinion, CJR’s healthcare desk, is part of our United States Project on the coverage of politics and policy. Follow @USProjectCJR for more posts from this author and the rest of the United States Project team. And follow Trudy Lieberman @Trudy_Lieberman.

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Trudy Lieberman is a fellow at the Center for Advancing Health and a longtime contributing editor to the Columbia Journalism Review. She is the lead writer for The Second Opinion, CJR’s healthcare desk, which is part of our United States Project on the coverage of politics and policy. Follow her on Twitter @Trudy_Lieberman.