More than 6.6 million young adults aged 26 and younger were enrolled in their parents’ insurance plans last year because of the Patient Protection and Affordable Care Act (ACA), the largest single-year increase in medical coverage for the age group. The section of the law that allows young people to remain on parental plans helped boost coverage during tough economic times, said Sara Collins, vice president for affordable health insurance at the Commonwealth Fund.
The benefit for young adults is one of the most popular parts of the ACA as young adults face a labor market that makes it difficult to find a job with healthcare coverage. Unemployment among 16- to 24-year-olds is 16.1 percent, almost double the 8.2 percent rate for the nation as a whole. “The economy is absolutely a factor in both the large number of adults who are without health insurance and likely the number coming onto their parents’ policies,” Collins said. The ACA “came at a really good time for young adults, in terms of the poor job market.” Adding young adults to their parents’ coverage was one of the first provisions of the law enacted. Approximately 71 percent of Americans polled by the Kaiser Family Foundation said they viewed that provision favorably. The ACA in its entirety is less popular, with an approval rate of 37 percent, and an unfavorable view by 44 percent of those surveyed in May, according to Kaiser’s monthly tracking poll.
President Barack Obama’s $1 trillion, 10-year plan to overhaul the healthcare system was passed by Congress in 2010 without a single Republican vote. Parts of the law were then challenged as unconstitutional by 26 states. The Supreme Court is slated to rule on those objections, a decision that could overturn the law. The head of a caucus of 21 Republican lawmakers with medical backgrounds said that no matter the outcome, he will try to preserve the coverage for young adults and for people with pre-existing medical conditions. Representative Phil Gingrey (R-GA), an obstetrician-gynecologist, believe that the young-adult provision is “a good policy.”
Despite this, the Commonwealth Fund report found that almost 40 percent of young adults between the ages of 19 and 29 did not have health insurance in 2011. Another finding is that more than 36 percent of young adults had medical bill problems or were in the process of paying off medical debt. Of those young Americans, 43 percent were experiencing serious financial troubles; 32 percent had trouble making their student loans or tuition payments; 31 percent deferred education or career plans, and 28 percent couldn’t afford food, heat or rent because of medical bills.
Because of the high cost of healthcare, young Americans are not having prescriptions filled, skipping recommended tests or treatments, avoiding doctor visits and failing to get specialist care when they need it. And, according to doctors. young adults don’t listen to medical advice once they hear how much treatment costs.
Dr. Jeffrey Hausfeld is well aware of the debt problem. As co-owner for FMS Solutions, a collection agency that specializes in medical debt, Hausfeld has seen a 50 percent increase in the amount of debt held by young adults over the last several years. He cited “the tremendous cost shift” to patients caused by high-deductible insurance plans, co-payments and co-insurance, said Hausfeld, an ear, nose and throat doctor who no longer practices. “Getting sick isn’t something that a healthy 26-year-old expected to have to pay for. They didn’t budget for it,” Hausfeld said. “Now they’re sitting with a $10,000 hospital bill and they don’t know what to do.”
“While the Affordable Care Act has already provided a new source of coverage for millions of young adults at risk of being uninsured, more help is needed for those left behind,” Collins, said. “The law’s major insurance provisions slated for 2014, including expanded Medicaid and subsidized private plans through state insurance exchanges, will provide nearly all young adults across the income spectrum with affordable and comprehensive health plans.”
Commonwealth Fund President Karen Davis said that the survey is a hopeful indicator at a time when millions of Americans have trouble getting access to needed healthcare. “The new report…shows that implementation of the law has already begun to make a difference for young adults, their families and other Americans,” she said. Allowing young adults, the majority of whom are healthy, to remain on their parents’ health plans is not as expensive as expanding coverage to populations with higher medical costs, although independent analyses estimate the expansion could boost premiums one percent to two percent.
Young Americans who had no healthcare coverage faced the greatest risk: 51 percent with a gap in coverage had a medical bill problem or medical debt. The costs could be substantial. One-quarter of young adults paying off medical debt owed $4,000 or more; 15 percent reported $8,000 or more in debt. Among those who were paying off debt, 31 percent owed $4,000 or more; 21 percent had $8,000 or more; and 11 percent had $10,000 or more.
“There’s no question that young people have cut back on high-value screenings, doctor visits and therapies,” Dr. Mark Fendrick, director of the University of Michigan Center for Value-Based Insurance Design, said. “You twist your knee playing soccer and you go to get an MRI. But if the doctor says you have to pay 50 percent of the cost, you’re going to be less likely to go through with it,” he said.