The first open enrolment period for Obamacare ended this March. Despite the cringe-worthy ads, it was a success. 9.5 million Americans now have health insurance through the Affordable Care Act – a huge step forward for President Obama’s vision of universal healthcare for the country. The rate of uninsured adults has dropped from 20% last year to 15% this year (1). Given the disastrous roll-out phase of the program, this surge in enrolment is encouraging to those who view Obamacare with a glass half-full attitude. However, there are still roadblocks on the path to equitable and affordable health care for Americans. One of these is the fact that young Americans simply aren’t signing up for health insurance as much as they should.
According to the just-released Commonwealth Fund poll, 18% of young adults (ages 19-34) are currently uninsured (1). This figure is much lower than last year, but is still higher than the nationwide-average of 15%. It’s strange, because the idea of universal healthcare was likely a big draw for young democratically-minded Americans hoping for a more equal society under Barack Obama. So why aren’t we buying in?
Being young, we feel invincible. And rightly so – young people enjoy the best health. In fact, as a young person, it can be more expensive to visit the ER if you are insured versus not. A recent study estimated that an uninsured young adult visiting the ER once in 2014 will pay an average of $2,022 in out-of-pocket costs (2). On the other hand, the average insured young adult visiting the ER once will pay $2,791 in the 2014 year for their insurance premium and the remaining out-of-pocket cost of the ER visit. This example is a bit extreme, since it assumes that the only healthcare used in one year would be one ER visit. More realistically, the insured person would win out in the end if he or she uses other healthcare services as well. But, it exemplifies how you wouldn’t necessarily save money as a young person if you have a medical emergency. Even with the cost of the penalty for not buying insurance (which will go significantly up in future!), it can still be cheaper to go uninsured.
The question of whether or not to buy health insurance as a young person is a game of risk, and how much of it we’re willing to bear.
Another issue is that we don’t bother to educate ourselves about health insurance, and the government doesn’t do much to help us. Over one-quarter of Americans aged 19 to 29 didn’t even know that the ‘Health Insurance Marketplace’ – the online portal for getting information, comparing plans, and purchasing health insurance – even exists. That’s a huge problem. But, it’s not entirely our fault. Even for highly educated young adults, the HealthCare.gov website can be remarkably difficult to navigate. A study recently published in the Annals of Internal Medicine recorded the following problems with the website (3):
- Poor explanations of technical health insurance terms
- An overwhelming amount of information
- It’s not clear that preventive health services like cancer screenings are always free (they are!)
- It’s difficult to figure out which plan is best suited to you and your needs
- The ‘catastrophic’ insurance category sounds scary
If young, highly-educated people encounter these seemingly basic problems, then that’s a scary thing. Think about how older adults with lower education, or whose first language isn’t English might do when trying to make a good decision when buying health insurance. It’s really difficult to communicate complex risk information, and as a result most people (even young, highly educated people!) have low ‘risk literacy’. Check out this 3-minute Risk Literacy to see how well you do – you might be surprised.
So, what’s the take-home message? As always, no matter whether you are old or young, or whether you have health insurance or not, take the time to educate yourself so that you can make the best decisions and be in control of your own health and how it’s taken care of. The benefit of Obamacare to the country is obvious now after this open enrolment period. The new Commonwealth Fund report states that:
By June , six of 10 adults with new marketplace or Medicaid coverage said they had used their insurance to go to a doctor or hospital or to fill a prescription. A majority said they would not have been able to access or afford this care before enrolling.
If you are a young American and don’t have health insurance, you really should look into getting some. You might find that it’s not worth it for you, and that’s fine. It’s a politicized issue too, so it’s good to decide what stance you take on it. Every citizen plays a role in the future of Obamacare, and be extension, the future of equality and the welfare state in America. And, the penalty fee is going to be quite hefty in the next few years if you don’t sign up (4).
Image source: http://doyougotinsurance.com/
1) Collins SR, Rasmussen PW, Doty MM. Gaining Ground: American’s health insurance coverage and access to care after the Affordable Care Act’s first open enrolment period. Commonwealth Fund. Report number: 1670, 2014.
2) Pratini N. The $1000 mistake? Why getting insured is 5x more costly for healthy young adults in 2014. http://www.nerdwallet.com/blog/health/2014/01/14/cost-health-insurance-young-adults/ (accessed 13 July 2014).
3) Wong CA, Asch DA, Vinoya CM, Ford CA, Baker T, Town R, et al. The experience of young adults on HealthCare.gov: suggestions for improvement: a case report. Ann Intern Med 2014; doi:10.7326/L14-0287
4) Patton M. Obamacare: Penalties and exemptions. http://www.forbes.com/sites/mikepatton/2013/10/28/obamacare-penalties-and-exemptions/ (accessed 13 July 2014).