Perhaps the biggest irony of the Patient Protection and Affordable Care Act is that if youre young and healthy, youll likely to end up paying higher premiums for individual health insurance than someone who is old and frail or with high-cost medical conditions.

The health care reform law restricts insurers from charging older, sicker policyholders more than three times what they charge younger, healthier members under a policy known as community rating.

The law also prohibits insurers from rejecting very sick individuals or those with pre-existing conditions that are more costly to treat. But the higher costs for treating those patients will be spread among younger, healthier Ohioans obtaining coverage on their own or through government-run health exchanges expected to go on-line next year, experts say.

A report prepared for the Ohio Department of Insurance by Seattle-based Milliman Inc. found that a healthy young male in Ohios individual health insurance market paying about $200 a month in premiums in 2010 could see his health insurance costs increase from 90-130 percent when the health exchanges begin signing up new enrollees in October.

By contrast, someone age 60 or older in the individual health insurance market could see their premiums fall by as much as 40 percent as a result of the community rating restrictions.

Melissa Thomasson, a Miami University professor who teaches classes on the economic impact of the Affordable Care Act, said the community rating was necessary to ensure that the sick and uninsured could get coverage, which was one of the reform laws main goals.

Young healthy people pay the lowest health coverage rates now because theyre less likely to suffer from disease, Thomasson said. On the other hand, many sick people are priced out of the market, if its available at all. The only way to make insurance coverage available for sick people is essentially to use healthy people to subsidize it.

Still, forcing young people to pay more to help cover the cost of caring for the elderly and chronically ill could have the unintended consequence of driving health care costs up for everybody. Some individuals and small businesses will drop health insurance coverage due to significant premium increases, experts predict, and others will simply decide to remain uninsured due to financial constraints.

That would pose a problem for the health exchanges, which would be left with a disproportionate number of older, more costly enrollees and too few healthy individuals to help absorb those costs.

Lets say no young people participated. In that case, the community rating would have to go up, and wed be back to square one because then wed have a bunch of sick people and older people in those exchanges at rates they really cant afford, she said.

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Premiums to rise under health care law