By Sarah Kliff
The Washington Post
— Coined by the health insurance industry, the term "young invincibles" has come to describe 18- to 34-year-olds who go without coverage because they expect to remain healthy. But young invincibles are crucial to making the Affordable Care Act work: The White House is counting on them to buy coverage under the new law, helping to spread the risk and hold down premiums for everybody. Let's debunk a few myths about who these uninsured young people are and what they want from the health-care system.
1. Young adults are uninformed about the health-care law.
Young adults tend to be about as aware of the health-care law as the rest of the population. A Kaiser Family Foundation poll in August found that 33 percent of adults had heard nothing about their state health insurance exchanges. That figure was 43 percent among 18- to 25-year-olds and 41 percent among 26- to 35-year-olds. Separate polling from the Pew Research Center found that young adults were more aware than any other demographic that the health-care law offers subsidies for low-income Americans to purchase insurance. However, they were less aware of the requirement to buy coverage.
Young Americans are especially aware of the provisions that affect their own coverage options, most prominently the option to stay on their parents' insurance plans until age 26. A Commonwealth Fund poll in March found that 62 percent of young adults knew of that program.
2. They don't want health insurance.
Young adults do have the highest uninsured rate of any demographic, with about 27 percent of people between 19 and 34 lacking insurance coverage, according to the Kaiser Family Foundation. But health-care experts say this doesn't necessarily mean that they don't want insurance, but rather that they are less likely to be offered coverage through their employers. That's because more young people work part-time or hourly-wage jobs that do not offer health benefits. When offered coverage by their employers, about 80 percent of young adults sign up — about the same rate as older workers.
Millions of young adults have also gained coverage under the health law's provision that allows them to stay on their parents' health insurance until they're 26. The Department of Health and Human Services estimates that, since this option became available in 2010, more than 3 million young adults have taken advantage of their parents' insurance plans.
When the Kaiser Family Foundation surveyed young adults about health insurance coverage in June, it found that about three in four said it is "very important" to them to have health insurance.
3. They don't need health insurance.
While young adults tend to have lower health-care costs, without coverage they can incur substantial bills. One Centers for Disease Control and Prevention study found that 17 percent of women ages 18 to 29, and 13 percent of men, have a chronic condition such as cancer or diabetes. Federal data show that young adults have higher rates of car accidents, which could lead to pricey medical bills. The high cost of maternity care can be another concern for young adults, with the average charges ranging upward of $32,000, according to a study published this year by Truven Health Analytics.
Young adults without insurance report difficulties accessing care and paying their medical bills. A 2011 study from the Commonwealth Fund found that more than half of uninsured young adults reported having a medical problem but not seeking treatment. Among insured young adults, that number was 19 percent. That same survey found that 51 percent of uninsured young adults had difficulty paying medical bills, with 26 percent having been contacted by a collection agency.
4. Young people will face steep premiums in the insurance exchanges.
The health-care law makes radical changes to the market for buying health coverage as an individual. For the first time, it requires insurers to accept all customers regardless of any preexisting health conditions. It also limits the amount that insurers can charge the oldest adults — premiums for elderly customers can't exceed three times the amount charged to the youngest subscribers.
To make the math work — and to cover the medical bills of older, sicker enrollees — insurers have often had to raise rates for young adults. They have also had to cancel some of the plans they offer younger subscribers, which tend to have lower premiums but less-robust benefit packages. That means that, in the exchanges, young shoppers might see much higher sticker prices and experience what the news media has called "rate shock."
However, many young adults won't have to pay the full price. Instead, most will qualify either for Medicaid — the public health program that serves low-income Americans — or for tax subsidies to help buy coverage. The nonprofit Families USA, which supports the health-care law, estimates that about 9.3 million people between 18 and 34 will qualify for a subsidy to purchase health insurance. Between these subsidies and Medicaid, the government estimates that about four in 10 young Americans will pay a monthly premium of less than $100 for a plan under the federal law.
Emily Wright, a 28-year-old student in Tennessee who had previously been without health insurance because of a preexisting condition, found a top-tier plan that cost $244 per month. Because she qualifies for a federal subsidy of $119, she is paying only $125 each month toward that premium. Since Tennessee isn't expanding Medicaid, she worried that she might not receive financial help: "I was nervous about what I was going to be paying, but it was actually a great deal."
5. Young people aren't signing up for health care yet.
While they haven't made up the majority of the health-care law's participants so far, young adults do account for some enrollment. In states that have released demographic information, such as Washington and California, young adults were about 20 percent of the first month's enrollment. In California, the state exchange had 6,924 people between ages 18 and 34 sign up for coverage, accounting for almost 24 percent of all enrollments in October.
Officials at state insurance exchanges say they expected older and sicker consumers to sign up first. They think younger people will sign up later in the open-enrollment period, which runs through March. White House officials have said they need about 40 percent of the consumers who buy plans on the exchanges to be younger than 35. "Those are pretty solid enrollment numbers for a younger demographic," said Michael Marchand, a spokesman for Washington state's Healthplanfinder. "Ideally we'd like to see the number go up in coming months."
Kliff covers health policy for The Washington Post and writes for Wonkblog.