This is the third blog in a series to highlight the dangers of the repealing the Affordable Care Act. Multiple times a week, Community Catalyst will highlight a different constituency to draw attention to the benefits the ACA has afforded them and to outline what a loss of coverage would mean.
While one of the primary goals of the Affordable Care Act (ACA) is to expand access to quality, affordable health coverage for all, young adults (ages 18-34) have benefitted more than many! ACA policies such as allowing children to stay on their parents’ plan, expanding Medicaid eligibility and offering tax credits to individuals signing up for individual marketplace coverage have all contributed to a remarkable decline in the rate of uninsured young adults. Overall, 6.1 million young people have gained coverage since the ACA’s passage, including 2.3 million who remained on their parents’ plan and 3.8 million who gained coverage through Medicaid or the marketplace.
However, the election of Donald Trump as president has left the ACA in peril. The president-elect has reaffirmed his campaign pledge to repeal the ACA and the Republican majority in Congress has put it at the forefront of their policy agenda. Although the new Republican leadership has yet to coalesce around a plan to replace the Affordable Care Act, what has thus far been proposed would likely cause millions of young adults to lose access to the affordable, continuous and robust coverage they’ve gained from the ACA.
Image Attribution: Newscast Online
What young adults stand to lose:
- Ability to stay on a parent’s plan until age 26: One aspect of the Affordable Care Act that garnered the largest amount of support from both policymakers and the public is the requirement that insurers offering dependent coverage make that coverage available to children until age 26. As a result of this change, young adults ages 18-25, who were one of the least likeliest populations to have insurance, experienced a 52 percent decline in their uninsured rate. Additionally, those ages 26-34 saw a 36 percent decline in their uninsured rate.
- Help purchasing affordable coverage: Currently, the ACA provides tax credits to individuals based on their income to help pay for premiums, with lower-income individuals receiving more assistance than higher-earners. In contrast, the proposed replacement plans would offer flat-dollar amount tax credits based on age while ignoring other factors such as health and income level. Under this plan, young adults would receive the smallest amount of financial assistance, disadvantaging young adults with chronic health problems or who are low-income. As Sarah Kliff of Vox.com wrote, “This means that Bill Gates would qualify for the largest tax credit simply because he is 61 years old…[c]onversely, a 23-year-old with little income and health issues gets minimal help...despite the fact that he may need support much more than Gates does.”
- Loss of flexibility for changing circumstances: Compared to other groups, young adults have been more likely to be uninsured and twice as likely to lose coverage during the year. Activities that cause a loss of coverage, like graduating from college, aging out of parents’ coverage or leaving a job are all more likely to be experienced by young adults. Similarly, young adults are more likely to experience a life event, such as having a baby or getting married, that might necessitate getting coverage. The ACA sought to prevent these individuals from slipping through the cracks of coverage by providing special enrollment periods (SEPs), 60-day windows outside of the annual open enrollment period for individuals experiencing these types of life events to enroll in coverage. Unfortunately, Health and Human Services Secretary nominee Tom Price’s proposed replacement plan would substantially penalize anyone experiencing an insurance gap: insurers would be able to charge enrollees who experience a lapse in coverage up to 150 percent more than the standard premium price, and enrollees would be required to pay this increased amount for 18 months before they could pay the standard amount.
- Ability to enroll in expanded Medicaid: More than 15 million individuals have enrolled in Medicaid since the expansion began in 2014, including many low-income young adults. Unfortunately, many of the proposed replacement plans would eliminate the expanded Medicaid provided by the ACA, meaning that young adults who have taken advantage of this coverage would lose their health care. Prior to the ACA, more than half (52 percent) of uninsured young adults were in families with incomes under 133 percent of the federal poverty level (FPL). The decision of 32 states (including D.C.) to expand their Medicaid program represented one of the largest opportunities for the low-income, young adult population to gain coverage.
The results of the 2016 election have created new threats to the ability of young adults to access quality, affordable health care. Together, we must work to protect the reforms to private health insurance and Medicaid that have allowed young adults to access care. To help protect coverage gains for young adults in the fight ahead, advocates should continue to highlight the stories of young adults who accessed health care through their parents’ health plans, on the Marketplace or due to expanded Medicaid. It is important that your congressional delegation and the state stakeholders who influence them understand the role the ACA has played in ensuring coverage and security for this population.