By Randy Tucker, Dayton Daily News, Ohio
McClatchy-Tribune Information Services

March 23--More than 5 million Americans, including nearly 80,000 Ohioans, have signed up for private health plans under the Affordable Care Act, offering the Obama administration a glimmer of hope that it can come close to its revised goal of 6 million enrollees by the end of the month.

But the true success of the law will depend less on the final tally than on whether it can attract the right mix of old and young people necessary to control costs for insurers and hold down rates for consumers.

To remain viable, experts say, the new health insurance system needs a significant share of healthy young adults to sign up and pay premiums to offset the typically higher medical costs that insurers must cover for older Americans.

So far, only about a quarter of adults enrolled in health plans sold through state and federally run health care marketplaces are between the ages of 18 to 34, according to the latest figures from the U.S. Department of Health and Human Services (HHS), which is responsible for implementing the health care law.

That's well below the White House's original expectations set by the Congressional Budget Office, which predicted that 40 percent of enrollment in the marketplaces would need to be young adults to represent their share of the uninsured in the general population and balance out the risk pool for insurers.

But some insurers have said the 40 percent is on the high end for what is necessary to balance the pool. And after a slow start -- largely attributable to computer glitches that stalled enrollment at, the government website for enrollment -- sign-ups among young people have begun to accelerate.

Young adults accounted for 27 percent of marketplace enrollment last month, which was three percentage points higher than the young adult share through the end of December, HHS reported.

In Ohio, the percentage of young adults enrolling in marketplace plans rose from 19 percent through the end of December to 21 percent through the end of February, or just under 17,000 individuals.

Advocacy groups and others who have been helping to enroll students and other young people acknowledge they face an uphill battle to significantly boost the share of so-called "young invincibles," who rarely get sick and may believe they don't need health insurance.

"For a lot of people, regardless of age, health care is not a priority...and young people use health care less than anyone," said Trey Daly, Ohio state director for Enroll America, a Washington, D.C.-based non-profit, which recently launched a

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