Conservative pundits, think tanks and bloggers are cheering a new analysis which claims to show "Why the 'Young Invincibles' Won't Participate in the ObamaCare Exchanges." Even with the Affordable Care Act's subsidies to help uninsured Americans purchase coverage, David Hogberg of the National Center for Public Policy Research argues, three million young adults ages 18 to 34 will be $1,000 better off if they forgo insurance and pay the penalty. With the Obama administration needing 2.7 million of them to enroll in order to offset the cost of insuring older, sicker adults, Hogberg concludes, the Affordable Care Act is headed for a "death spiral."
For conservatives committed to sabotaging Obamacare, that prospect is generating a near-orgasmic response. Unfortunately for them, Hogberg is telling only half of the story. While he lays out the costs for young adults obtaining health insurance in 2014, he predictably leaves out the benefits if they actually get sick. As it turns out, the numbers show that millions of Young Invincibles have already gained insurance thanks to the ACA. Just as important, surveys show how worried they are about going without.
As you may recall, since September 2010 the Affordable Care Act has enabled young adults to join or remain on their parents' insurance policies up to age 26. By May 2011, 1.2 million did just that. By the end of the year, a Commonwealth Fund analysis estimated that:
In 2011, 13.7 million young adults ages 19 to 25 stayed on or joined their parents' health plans, including 6.6 million who would likely not have been able to do so before passage of the Affordable Care Act.More on this below the fold.
Despite that progress, the Department of Health and Human Services says 19 million people between the ages of 18 and 34 remain uninsured. Up to 9 million may qualify for coverage under the ACA's expanded Medicaid program. And while subsidies for those earning up to 400 percent of the federal poverty level ($14,484 for a single person in 2011) for the others may not cover all of the costs of obtaining coverage, the math for young adults is more complex than that. As the Commonwealth Fund reported in June 2012:
Nearly two of five (39%) young adults ages 19 to 29 went without health insurance at some time in 2011, and more than one-third (36%) had medical bill problems or were paying off medical debt. Of those who reported problems with medical bills or debt, many faced serious financial consequences such as using all of their savings (43%), being unable to make student loan or tuition payments (32%), delaying education or career plans (31%), or being unable to pay for necessities such as food, heat, or rent (28%)...Writing in the New Republic, Jonathan Cohn offered six reasons why the Young Invincibles will probably sign up for insurance at or above the numbers HHS is targeting.
The amount of medical debt was often substantial. One-quarter of young adults who were paying off medical debt owed $4,000 or more, and 15 percent reported $8,000 or more in debt. Among those with a gap in coverage during the year who were paying off debt, 31 percent had $4,000 or more of medical debt, 21 percent had $8,000 or more, and 11 percent had $10,000 or more.
It is not just that only a quarter of them said in a recent poll they won't obtain insurance and pay the penalty (a penalty which increases over time). As it turns out, young adults clearly see the value of health insurance when they can get it and when they can't:
The other poll, published in June, is from the Kaiser Family Foundation. Eighty-seven percent of young people surveyed said they considered it "personally important" to get insurance, 88 percent said "insurance is something I need," and 66 percent said they worried about paying medical bills in case of injury or illness. [...]It's not just the polling that suggests those critical young adults will purchase insurance in the numbers Uncle Sam needs. Right now, there is a real world experiment going on in with the individual mandate in Massachusetts. While the state overall has seen in its uninsured rate drop from 10 to about two percent, the gains among the Young Invincibles have been striking. As the Commonwealth Fund reported:
Still, the best indicator of how young people feel about insurance may be the way they respond when they have full-time jobs and their employers offer coverage. According to Aaron Smith, president of the group Young Invincibles, around seven in ten young people opt for insurance, even though it means sacrificing some take-home pay. That's nearly the same take-up rate as older Americans have.
In 2006, Massachusetts passed a reform law very similar to the Affordable Care Act, with subsidized health insurance options as well as an individual requirement to have health insurance. Sharon Long and colleagues found that in Massachusetts there has been substantial compliance with the mandate among young adults. The uninsured rate among young adults ages 19 to 26 in the state declined by more than 60 percent in the year following the rollout of the law, falling from 21.1 percent in 2005-2006 to 8.2 percent in 2007-2008. In New York, which had no mandate or coverage expansion over those years, the uninsured rate among young adults remained at 27 percent.All of this evidence suggests that the likes of the Washington Examiner, the Washington Free Beacon, The Daily Caller, the American Enterprise Institute and the Heritage Foundation shouldn't count their Obamacare chickens before hatch. If the Obama administration is successful in its outreach, the typical Young Invincible will likely conclude the benefits of the President's program will outweigh its costs. Besides, our representative Young Invincible has already heard the Republicans' plan for him should he become seriously sick or injured. A September 2011 Republican presidential debate revealed the GOP's approach: "Let him die."