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Robert Bauer is young, lean and healthy -- just the kind of person the government wants to buy into its new health insurance exchanges. 


Bauer though, doesn't see the need. The 24--year--old works in organic farm fields three days a week, and prides himself on eating well. He's uninsured now and doesn't plan to buy coverage this fall in the exchanges, a key part of the federal overhaul of health programs in the Affordable Care Act. "I just don't think it's worth the money for me to get health insurance at this point."


Bauer may not worry about a health crisis, but the people building insurance exchanges worry about Bauer and the millions of other healthy Americans who they fear may simply opt out. They need those younger, low-risk people to pay premiums to offset the costs of covering older, sicker Americans.


The law requires Americans obtain health insurance or pay a penalty. The question is whether young people, starting in October, sign up or just pay the penalty, which in the first year isn't much, the greater of $95 or 1 percent of income in 2014. Officials, increasingly concerned that young, healthy people will simply tax the penalty, are searching for ways to lure them in.


"It's important for everybody to participate all of the time and to pay an average amount in premiums so that when something happens to one of us -- we have a baby, we get cancer... that will require thousands of dollars of care, the money is there in the pool," said Karen Pollitz of the non-partisan Kaiser Family Foundation.


People in their twenties tend to use healthcare less than a person in their sixties, she added, so healthier people are important to making the overall risk pool work.


Young people aren't against being insured. A Kaiser Family Foundation poll found that about three-fourths of ages 18 to 30 surveyed would like to have health insurance. The top reason younger people didn't have it: too expensive.


Delivering the message that getting covered is the right thing to do, though, may prove difficult.


Massachusetts found that out. Like the federal mandate, the Bay State passed a law requiring its residents to obtain health care coverage or pay a fine.  


Looking to reach a wider audience, the state partnered with the Boston Red Sox and its New England Sports Network to encourage residents who lacked insurance to sign up through its online insurance marketplace, the Connector, Massachusetts' version of MNsure, what Minnesota will launch this fall.  


Fans at Fenway Park were a captive audience for ads touting the Connector on the Jumbotron or articles tucked inside game day programs. When nature called or it was time for a concession stand run, fans could visit an information booth where Red Sox pitching great Luis Tiant talked about controlling his diabetes as well as his famous corkscrew windup.


The public relations pitch stumbled at first as the public reacted poorly to TV ads featuring baseball players.


Uninsured people "didn't want anyone who had insurance and was making a good salary to sort of lecture them.  It came off as 'you better do this,'" said Tara Murphy of the public relations firm Weber Shandwick, who led the Massachusetts campaign.


The campaign switched gears. The Red Sox still provided the platform but the messages came instead from young people who'd suffered serious illnesses or crashes and others who were able to find affordable coverage on the state's new marketplace. TV ads featured a young woman sitting in a green stadium seat at Fenway talking about her life following a breast cancer diagnosis. 


Minnesota has been talking with its pro teams, including the Twins, Timberwolves, Vikings, and the Lynx to encourage residents to sign up for coverage, borrowing a page from the Massachusetts playbook. The lessons learned out east could help here and in other states, Murphy said.


The Affordable Care Act, also known as Obamacare, lets young adults stay on their parents' insurance until age 26. But for the most part, they don't have access to affordable insurance once they graduate high school or college.


"We boot them off," Pollitz said. "We kick them out of Medicaid, their parents' health insurance coverage just when they're starting off, just when they're not earning much and the odds are pretty low that they're going to get that first great new job with new benefits."


Bauer, a University of Minnesota grad who'll study agronomy this fall at Virginia Tech, says he'd pay the $95 penalty if he didn't have access to affordable health insurance starting this fall. (The penalty rises to $695 or 2.5 percent in 2016.)


He hopes that if he got seriously ill or had an accident his family would have the resources to help. "Maybe I'd just lose my life," he added, "and that would be OK, just so other people wouldn't have to live the rest of their lives in poverty or bankruptcy."

This story was produced as part of collaboration between Kaiser Health News, NPR, and MPR News.

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Many young adults may not worry about a health crisis, but the people building insurance exchanges worry about the millions of other healthy Americans who they fear may simply opt out. They need those younger, low-risk people to pay premiums to offset the costs of covering older, sicker Americans.

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