WASHINGTON — People signing up for health insurance through the Affordable Care Act's federal and state marketplaces tend to be older and potentially less healthy, officials said Monday, a demographic mix that could threaten the law's economic underpinnings and cause premiums to rise in the future if the pattern persists.
Questions about the law's financial viability are likely to become the next line of attack from its critics, as lawmakers gear up for the midterm elections this fall. Republicans quickly seized on the government's progress report on Monday as evidence that the health insurance law would not work.
But administration officials expressed optimism that more young people would sign up in the months ahead, calling the latest enrollment numbers "solid, solid news" for the health care law. They said that interest in obtaining insurance through the marketplaces was increasing sharply across all age groups and that youth outreach efforts would become more aggressive as the March 31 open enrollment deadline approached.
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Nearly 2.2 million people picked a health insurance plan through the exchanges established by the Affordable Care Act through Dec. 28.
"We're pleased to see such a strong response and heavy demand," said Kathleen Sebelius, the secretary of health and human services. "Among young adults, the momentum was particularly strong."
Of those who signed up in the first three months, administration officials said, 55 percent are age 45 to 64. Only 24 percent of those choosing a health insurance plan are 18 to 34, a group that is usually healthier and needs fewer costly medical services. People 55 to 64 — the range just below the age at which people qualify for Medicare — represented the largest group, at 33 percent.
The latest figures about enrollment add pressure o n the Obama administration after a disastrous rollout of the HealthCare.gov website in October. Senior officials said they understood the stakes and were working to increase sign-ups. The White House recently hired Marlon Marshall, the deputy national field director for Mr. Obama's 2012 presidential campaign, to run a campaign-style effort aimed at increasing sign-ups, especially among young people.
Brendan Buck, a spokesman for the House speaker, John A. Boehner, Republican of Ohio, predicted that the White House would fail to meet its goals and said that insurance premiums would rise.
"There's no way to spin it: youth enrollment has been a bust so far," Mr. Buck said. "When they see that Obamacare offers high costs for limited access to doct ors — if the enrollment goes through at all — it's no surprise that young people aren't rushing to sign up."
The demographic information, which had not been broadly available until Monday, also offers the first concrete evidence about whether the national health care experiment will work the way it has in Massachusetts, where a government marketplace also offers insurance to people who do not receive it through their employers. Officials said they were optimistic because the pattern of sign-ups among young people looked similar to the one they had seen in that state, which had a surge in sign-ups as the deadline approached.
Over all, officials said that 2.2 million people had signed up by Dec. 28 for health insurance through HealthCare.gov an d the state-based websites. Administration officials have previously said they hope to see seven million people enrolled in private health plans through the federal and state exchanges by March 31.
Of those who signed up, about 54 percent are female and 46 percent are male. Nearly 80 percent of those who selected a plan qualified for federal subsidies to reduce their premiums, officials said. Federal officials said they did not know how many people selecting plans were previously uninsured or how many have paid premiums. People are required to pay their share before coverage takes effect. Officials also did not know the race or ethnic origin of those who signed up.
The age breakdown was the most highly anticipated data being released because of what it could say about the health of those who will be insured. Under the law, insurers can no longer deny coverage or charge higher premiums because of a person's medical history or pre-existing conditions. As a result, White House and health policy experts have repeatedly said that insurers need to sign up large numbers of younger people to balance the financial risks of covering older Americans who require more medical care.
Larry Levitt, a senior vice president of the Kaiser Family Foundation, has said that "the mix of enrollment is much more important than the total number."
"If you assume that sicker individuals are likely to come in first, then a smaller pool is likely to be a sicker pool," Mr. Levitt said. "The best guarantee of a diverse p ool is a big pool, because that means you are probably reaching younger and healthier people."
Mr. Levitt said that people enrolling early included some with the greatest needs: people who had been locked out of the individual insurance market because of serious illnesses and those coming from federal and state programs for people with pre-existing conditions.
The report from the administration showed that older Americans accounted for a large share of those choosing health plans in a handful of states, including West Virginia and Wisconsin, where 66 percent were age 45 to 64. In Maine, 64 percent were in that age bracket, and in Arkansas their share was 63 percent.
Robert Laszewski, a consultant who works closely with insurers, said, "You need healthy people of all ages," and so far, he said, "the program is not ramping up fast enough to guarantee a good balance of healthy and sick people, which you need to sustain the program."
Robert E. Zirkelbach, a spokesman for America's Health Insurance Plans, a trade group, said "it's too early to know" if the enrollment of younger and healthier people was adequate to keep premiums stable in coming years. Insurers will need to see enrollment numbers for the full six-month period, he said.
Many people who bought insurance on their own have received notices saying their policies were being canceled or discontinued because the policie s did not comply with coverage requirements of the new health care law. Those expecting high medical bills had the strongest motivation to overcome the obstacles to buying insurance on the federal exchange.
Caroline F. Pearson, a vice president of Avalere Health, a research and consulting company, said that "early enrollment is skewed toward older individuals." She added: "Sicker, older folks tend to sign up first because they are more motivated. They are likely to have health care costs early in the year."
Anne Filipic, the president of Enroll America, a nonprofit group trying to expand coverage, said, "We know from our research that when uninsured consumers learn about the financial help that is available to them, they are eager to enroll.� �
Health plans in the marketplace are separated into four categories — bronze, silver, gold and platinum — indicating the generosity of coverage, or the share of costs paid by insurance for an average enrollee. Of people choosing plans so far, 60 percent selected silver plans and 20 percent signed up for bronze plans. Thirteen percent chose gold plans, and 7 percent platinum coverage.
In December, for the first time since the marketplaces opened, the number of people selecting plans in the federal exchange exceeded the number signing up through state exchanges.
For the first hal f of the enrollment period, through December, the federal exchange, which serves 36 states with about two-thirds of the nation's population, accounted for 56 percent of those selecting plans. The other 44 percent were in state exchanges.
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