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Health Policy Brief: Young Adults and the Affordable Care Act

December 16th, 2013
by Tracy Gnadinger

A new Health Policy Brief from Health Affairs and the Robert Wood Johnson Foundation explores one crucial ingredient necessary for the Affordable Care Act to succeed: the enrollment of millions of young Americans. According to 2008 census data, three out of ten legal US residents are between ages 19 and 29. Yet, according to the same data, young adults have usually been uninsured at far higher rates than any other age group. This health policy brief looks at how the Affordable Care Act will extend coverage to millions of young adults, even though many will likely remain uninsured. (In addition, T.R. Goldman provides a progress report on the ACA’s dependent coverage expansion.)

Topics covered in this brief include:

  • What’s in the law? If a young adult does not receive insurance from an employer, there are other mechanisms for acquiring coverage. These include: continuing coverage on a family plan until age 26, expanded Medicaid coverage, and purchasing an individual plan in the new insurance Marketplaces. The brief explains how each option is meeting its goals–or not. For example, the Affordable Care Act was premised on nationwide Medicaid expansion to incomes of up to 133 percent of the federal poverty level–nearly half of the uninsured adults under age 35. However, the Supreme Court’s June 2012 decision gave states the option of not expanding Medicaid. As a result, in the states that have chosen not to expand Medicaid, many young uninsured Americans will be shut out of the program. At the same time, some 9 million young adults with slightly higher incomes–133 percent to 400 percent of the federal poverty level–are now eligible for premium tax credits to help them purchase coverage through the individual exchanges.
  • What’s the debate? As enrollment in the exchanges goes into its third month, the question remains: Will young Americans enroll? As the brief points out, the evidence so far is not clear. A recent poll found that fewer than three in ten uninsured millennials say they will enroll; however, in Massachusetts, this group waited until the last minute to sign up, something that could happen on a national level. The brief points out that cost, not hubris, may be driving the choices of those remaining uninsured. According to a Kaiser Family Foundation health tracking poll, 52 percent of respondents opted out of insurance because it was too expensive, not because they felt they didn’t need it.
  • What’s next? As the deadline for enrollment approaches, another survey finds that the vast majority of uninsured people ages 19-29 remain unfamiliar with either the exchanges or the expansion of Medicaid eligibility. An array of groups–government, insurance companies, and nonprofits–are expanding their outreach efforts to persuade these Americans that they are not invincible and that affordability is no longer an obstacle to health insurance. The next few months will be crucial, as the enrollment deadline closes in.

About Health Policy Briefs. Health Policy Briefs are aimed at policy makers, congressional staffers, and others needing short, jargon-free explanations of health policy basics. The briefs, which are reviewed by experts in the field, include competing arguments on policy proposals and the relevant research supporting each perspective.

Sign up for an e-mail alert about upcoming briefs. The briefs are also available from the Robert Wood Johnson Foundation’s website. Please feel free to forward the briefs to any of your colleagues who are tracking health issues. And after you’ve taken a look, we welcome your feedback at:

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1 Response to “Health Policy Brief: Young Adults and the Affordable Care Act”

  1. Thom Bastian Says:

    The one variable that will also play a crucial role in enrollment among the youth is an adequately functioning website! The whole debacle with server and stability issues related to the website is dissuading a lot of Americans from enrolling at the moment. Once these kinks are worked out, I think we will be better able to accurately assess the success of the Affordable Care Act.

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