The ACA and Millennials: Time Will Tell

Recently, the media has delivered polarized opinions regarding how the Affordable Care Act (ACA) affects or will affect young adults. When reading news and op-ed headlines like “Why Obamacare is good for young people” (Klein, 2013) situated next to “Obamacare is really, really bad for you, especially when you are young” (Basu, 2013), it seems that young people should expect to feel lost when approaching such complex legislation. As these headlines demonstrate, the media has misrepresented the ACA as being either fantastic or detrimental for Millennials. Upon further investigation and review, it seems the reality is somewhere in-between “good” and yet to be seen “bad.”

The Good: This is easier to explain, because much of it is based on factors that can be measured or already enacted provisions within the ACA.

• “The percentage of young adults without health insurance has fallen by more than 4 percentage points since 2009, declining from 31.4 percent to 27.2 percent in 2012, or more than 1 million individuals” (Commonwealth Fund, 2013). Additionally, “The law has helped 6.6 million young adults who have been able to stay on their parents’ plans until the age of 26, including 3.1 million young people who are [now] newly insured” (Office of the Press Secretary, 2012). This provision prevents young adults from aging out of insurance coverage as they graduate from high school or college and has reduced the percent of young adults without insurance.
• There is always the option to opt out of ACA coverage and pay a penalty. This allows individuals to exercise their freedom and not buy coverage if it proves financially challenging or if their circumstances change. However, it allows people to risk not planning for accidents or unforeseen health needs that may require them to use healthcare services that are unaffordable without insurance. 
• There is more transparency. Under the ACA, insurers have to provide understandable information to consumers. “All consumers, for the first time, will really be able to clearly comprehend the sometimes confusing language insurance plans often use in marketing,” said HHS Secretary Kathleen Sebelius. “This will give [consumers] a new edge in deciding which plan will best suit their needs and those of their families or employees” (Department of Health and Human Services, 2012).
• All FDA approved birth control options are covered without copays, coinsurance, or deductibles (Centers for Medicare and Medicaid Services). This already existing provision immediately removes the barrier of up-front costs allowing for greater consumer choice and access--particularly for health services like birth control that young women are more likely to utilize.
• “Nearly 13 million Americans will receive a rebate this summer because their insurance company spent too much of their premium dollars on administrative costs or CEO bonuses” (Office of the Press Secretary, 2012). This benefit seems fairly obvious as it will allow a large portion of insured Americans to reinvest or reallocate those savings into goods and services they otherwise may not have been able to afford without the rebate (e.g., childcare, energy saving home appliances, or healthy foods/activities).

The Bad: The negative views regarding the ACA are often related to one of two ideas: the “what-ifs” and the “myths.” In this discussion, only the “what-ifs” causing apprehension among readers will be covered. Much of what is presented as “bad” about the ACA is speculative, and has yet to be seen. Prior to condemning or celebrating the law, time should be allowed to observe its enactment.

• 22 states are not expanding Medicaid at this time (Kaiser Family Foundation, 2013). Young adults that cannot get coverage under their parents’ plans might slip through the cracks. If they have to purchase insurance from the marketplace, budgeting premiums into an already stretched budget is not easy, even if premiums are kept under $100 per month. Honestly: affordability is largely subjective and may vary despite attempts like cost-sharing subsidies and tax credits attempting to control costs.
• Young adults may end up paying more for health insurance coverage than the health services that they consume and need. Some media sources have stipulated this is a bad thing because young adults could be subsidizing services they may not have the fortune of utilizing. Much like what is speculated about Social Security benefits, it is also difficult to know that there will be enough money in future generations to assist with cost-sharing for the millennial generations’ health benefits as they age. As former US President Bill Clinton recently said, “This only works. . . if the young people show up" (Taranto, 2013).
• With the unemployment rate being almost twice as high for young adults as for the general population—13% for young adults aged 20 to 24, and 7.3% as stated by the US Bureau of Labor Statistics--and living in a rapidly changing economy, the ability to pay premiums for marketplace insurance policies may vary from month to month, potentially creating financial insecurity for young adults. 

Overall, the Affordable Care Act is not a two-sided coin for Millennials. As with all large policy implementations, there will undoubtedly be challenges and hurdles to address over time. Since the ACA was enacted in 2010, we've already seen some successes. In proceeding to evaluate the Affordable Care Act implementation, it is important consider how both the positive and negative consequences will unfold for individuals.

Let's allow time to see if the “what-ifs” become "what is" before jumping to a conclusive or alarmist opinion.

Emily Gelber MSW, LSW
Illinois Health Matters Analyst
Health & Disability Advocates