Some would pay lower premiums on private insurance; others would lose Medicaid coverage
Darlin Kpangbah receives free health insurance through Medicaid and is grateful for the coverage in case of accidents, such as when she tore a ligament in her leg a few years ago. “I feel like I’m injury-prone, ” said Kpangbah, 20, who lives in Sacramento, Calif. Without insurance, she said, the injury “would’ve been huge to pay for.”
Young adults such as Kpangbah were among the biggest beneficiaries of Obamacare. The Affordable Care Act helped reduce the rates of uninsured millennials to record lows and provided millions of Americans with access to free or low-cost insurance as well as maternity care, mental health treatment and other services.
Now, Senate Republicans have proposed overhauling the law, a move that could help some young adults, by lowering the cost of their premiums in the private insurance marketplaces, but could hurt others who gained insurance through a massive expansion to Medicaid. A Congressional Budget Office analysis of the bill released Monday (June 26) estimated that 22 million Americans could lose coverage under the Senate bill. A day later, Senate Republicans postponed voting on the bill in the face of mounting opposition, so changes are likely.
The current form of the bill also would retain a popular Obamacare provision that let young adults stay on their parents’ insurance until they turn 26. But the bill also could dramatically reduce health coverage and care for other young adults, according to the bill’s many critics, which include the American Medical Association and the American Hospital Association.
“Don’t be fooled, ” said Jen Mishory, executive director of the advocacy organization Young Invincibles. “This is going to be a bad deal, particularly for the most vulnerable young people.”
Mishory said one of the biggest concerns is that states could choose not to make insurers provide benefits such as maternity care, mental health care and prescription drugs — all commonly used among young adults. “You will see a lot of young people not getting the kind of coverage they need, ” she said.
The proposed changes in the marketplaces, however, could make coverage more attractive to young people. The Congressional Budget Office reports that the Senate bill would result in a larger number of younger people paying lower premiums to buy private insurance. The proposal would let insurers charge older people as much as five times more than others, which could mean lower premiums for younger people.
At the same time, the Senate bill shifts the amount that people who qualify for subsidies must pay toward their own premiums. That means people younger than 40 might pay a smaller portion of their income toward coverage than they do under Obamacare.
But young adults could face other cost increases because of larger deductibles and less help with out-of-pocket expenses. Some no longer would qualify for subsidies at all, because the bill would reduce the income threshold for eligibility.
Millions of young adults have enrolled in coverage through the insurance exchanges. That’s partly because there has been a coordinated push to get as many healthy, young people into the marketplace, to balance out older, sicker consumers who were eager to sign up right away.
Of the 12.2 million consumers who enrolled in health insurance through the exchanges across the United States in 2017, about 27 percent were 18 to 34 years old. In California, 37 percent of 2017 enrollees were in that age group, according to Covered California, the state’s insurance exchange.
Steven Orozco, who lives in Los Angeles, is among them. He, his wife and 2-year-old daughter have a plan through Covered California. Orozco, a real estate agent, said they are all healthy so they don’t use it often, but he has it just in case of broken arms or other unexpected health needs. Orozco, 32, said he is concerned about what could happen in Washington and how that might affect his coverage, which currently costs about $450 a month.
Despite potential benefits to young adults in the private marketplace, the most damaging changes under the Senate proposal would be for young adults covered by Medicaid, said Walter Zelman, chairman of the public health department at California State University in Los Angeles. In addition to phasing out the expansion of Medicaid, the Senate bill also would result in reduced funding for the program, he said.
“The biggest impact on young people is the dismantling of Medicaid, ” Zelman said. Since the Affordable Care Act took effect, about 3.8 million young adults have gained coverage through the expansion of Medicaid, according to Young Invincibles.
In California alone, Zelman said, hundreds of thousands of young people won’t be able to access Medi-Cal, California’s version of Medicaid, if the expansion is phased out. Zelman, who worked to enroll Cal State students into health coverage under Obamacare, said that historically the highest percentages of uninsured people have been young adults, low-income residents, part-time workers and Latinos.
“Those are my students, ” he said. “And more generally, those are young people overall. … Anything that threatens [their] access to health is bad for them, ” he said.
It’s unclear whether the proposed Republican overhaul would result in more or fewer young enrollees.
Uninsured Sacramento resident Sydney Muns, 27, works at a nonprofit organization that doesn’t offer health coverage, and she made too much money to qualify for Medi-Cal or receive Obamacare subsidies. Muns said she hopes premiums and out-of-pocket costs will decline in the future so she can get coverage.
“It’s just not affordable, ” said Muns, who faces $50,000 in college loan debt. “I don’t know anyone my age who has insurance.”
But Chyneise Dailey, 24, said she plans to buy health care coverage regardless whether she is required to do so. Dailey, who works at Sacramento State University, remains on her parents’ Blue Cross health insurance plan, but knows she has only two years before she must leave it.
“You never know what can happen. You get into a car accident, you’re in the ER — do you want to pay full rate or do you want to pay your copay?” Dailey said. “I’d just rather be safe than sorry.”
Under both the Senate and House plans to overhaul Obamacare, young women who go to Planned Parenthood for reproductive health and other medical services could be hurt because of a provision to ban federal funding of the organization for a year.
