The Affordable Care Act and Young Adults
YOUNG, BROKE AND HEALTHY: WHY YOUNG ADULTS WILL DETERMINE THE FUTURE OF THE AFFORDABLE CARE ACT
By Silverio Ramirez, Health Fellow
Dubbed as the Young Invincibles, young adults between the ages of 19 to 25 have become the focus for health officials who will soon begin to roll out the last stages of the Affordable Care Act (ACA). As a demographic presently suffering from high uninsurance rates, with almost 15 million young adults between the ages of 19-29 being uninsured prior to the passing of the ACA—an increase of 4 million uninsured young adults in the past 10 years —there is concern in the health care community that young adults will pose a challenge in the mission of getting all Americans affordable health care coverage.
As a group heavily impacted by the economic downturn it gives many even more reason to believe young adults will not enroll in health insurance plans at the expense of other fiscal responsibilities they frequently encounter. A paycheck can only go so far when the list of bills for a young adult includes rent, tuition or student loan bills, groceries, and a myriad of other expenses that must be paid before even thinking about health insurance. A study conducted by the Commonwealth Fund outlines how 45% of young adults who delayed their care did so because of the high costs, and 58% of young adults who do get care claim to have difficulty paying medical bills.
The perception of the so called Millennials who find themselves too healthy and too poor to embrace health care insurance is what worries supporters of the new health care law. Without a base of healthy people dependably providing into the pool of health insurance premiums, the entire system by which the ACA was designed will collapse.
Research by the Kaiser Family Foundation has found the perception of healthcare coverage among young adults is positive, contrary to popular belief. In their July 2013 study the Kaiser Family foundation finds that more than 7 out of 10 young adults between 18 and 25 believe coverage is “important to them personally to have” and it is “something [they] need”. Even more illustrative of a young adults concern for their personal health is how young adults have very distinct healthcare needs other age groups do not have. The National Adolescent Health Information and Innovation Center has found young adults require care for issues such as mental health concerns, substance abuse, sexual health, and obesity at larger rates than other age groups.
THE AFFORDABLE CARE ACT HELPS YOUNG ADULTS IN MANY WAYS
The ACA allows for children under 26 years of age to remain on their parent’s or family policy. Under this provision young adults can remain on a parent’s insurance plan regardless of financial independence of dependence status, marriage status, or educational enrollment. Regardless of whether young adults are part-time or full- time students, had one or multiple jobs in the past month, or if these jobs have been full time or part time employment opportunities, the ACA allows young adults to have access to affordable health insurance. A young adult does not even have to live with their parents to qualify for this provision.
This provision was one of the earliest to be implemented and has led to a significant increase of young adults enrolling for insurance. The U.S. Department of Health and Human Services (HHS) reports nearly 3 million young adults have gained health insurance as a result of this provision. Even more promising, estimates show that by 2014, once the ACA has been fully implemented, more than 12 million of the 15 million uninsured young adults will have the opportunity to gain access to affordable coverage .
Preventative care is also highlighted in the ACA, requiring health plans to offer preventative services. Through preventative services offered at no expense of co-payments or deductibles, young adults now have access to health screenings such as those for diabetes, depression, HIV and sexuality transmitted infections, obesity, various cancers, and counseling for drug and tobacco use. The ACA requires women to be covered for services including but not limited to checkups and domestic violence counseling, as well as all FDA approved contraception methods.
After the Supreme Court decision on the ACA, States have the option to expand their Medicaid programs. Traditionally young adults faced the dilemma of having an income too high to qualify for Medicaid assistance but too low to have affordable health insurance. Before the ACA a young adult had to be of low income and then satisfy an additional provision to qualify for Medicaid benefits, such as having a child, being disabled or meeting age requirements. Depending on the acceptance of the Medicaid expansions, States can now have young adults who are child-less, do not have disabilities, non-pregnant qualify, and incomes no greater than 133% above the federal poverty level ($30,657/year for a family of four) for Medicaid benefits.
RATE SHOCK
There are health analysts who fear young adults, and any demographic who is not in dire need of health insurance, will experience an increase in premium costs under the new health care system compared to prices before the legislation became law. These fears are premised around the belief that healthy people will be subsidizing those with high costs of care, and be required to enroll into a medical plan that provides more services and are consequently more expensive.
According to research by the HHS Office of the Assistant Secretary for Planning and Evaluation (ASPE) it suggests these beliefs of higher care premiums are only speculation. ASPE finds that in eleven states where data is already available on the proposed insurance premiums, after full implementation of the ACA, the lowest cost for the silver plan (medium coverage) is on average 18% less expensive than original estimates by the Congressional Budget Office (CBO) .
For young adults, this research is very promising. In Los Angeles county, the county with the largest amount of uninsured Americans in the U.S., the lowest silver plan for a 25 year-old is $174 a month, and $117 a month for catastrophic (the most basic form of insurance). These averages are not only lower than previously estimated, but also do not take into account federal tax credits that can help young adults pay these low premiums in the individual market. Nearly all young adults qualify for tax credits. Only 7% of the 10.8 million young adults in the individual market do not qualify for tax credits or Medicaid expansions. To illustrate how these tax credits further help young adults afford health insurance, a 25-year-old who earns 150% of the Federal Poverty Level ($17, 235/year) could afford a silver plan (medium coverage) for $34 a month, and a Bronze plan (second to lowest coverage) for as little as $7 a month in California.
YOUNG ADULTS ARE THE KEY TO PREVENTATIVE CARE- BASED HEALTH The ACA
needs the enrollment of young adults. Weary of this, the legislation is built to entice those young adults who are healthy and do not believe they need health insurance through a system that allows for affordable premiums. Perhaps we live at a moment in our lives when other priorities might distract us from our own health, but to what point will be continue to ignore a basic fundamental right, especially when our participation in the new law will define how others benefit from it?
“Attention to health is life’s greatest hindrance”—Plato.