Most of us know someone who doesn’t have health insurance. In my case, it’s my little brother, David Kim.
David is 29-years-old and recently earned an advanced degree in international relations. He hasn’t been able to land a full-time job with health benefits. The two jobs he has now are temporary, and with such a precarious work situation, he just doesn’t think he can afford health insurance.
“I’m totally aware that if I get sick then I’m doomed financially,” Dave told me over a lunch break. “And maybe that's not a very financially sound decision to make, but it is nonetheless a risk that, for the time being, I’m prepared to take.”
Young adults —18 to 34-year-olds — make up more than 40 percent of California’s uninsured, though they make up less than 30 percent of the population. And according to many health reform advocates, they’re the ones who could make or break Obamacare.
“The success of this law really does depend on getting young people insured, and frankly getting everyone insured,” said Larry Levitt, a health policy and insurance expert for the Kaiser Family Foundation.
In less than five months, a key piece of Obamacare will go live: state-based insurance marketplaces, called Covered California here. That means millions of Californians looking for coverage for themselves or their families will be able to go online and enroll in qualified health plans regardless of their medical history. Many will get help from federal subsidies. But if the exchange doesn't enroll enough young, healthy people, insurers will have to hike everyone’s premiums.
“Insurance premiums are set based on the pool of people who are buying coverage,” Levitt said. “If we get only sick people, and don’t get the young, healthy people into the insurance system, it’s going to mean premiums are much higher.”
The health law has plenty of incentives to engage young people in insurance. They can stay on a parent's health plan until they’re 26-years-old. Some will qualify for expanded Medi-Cal, the state’s health insurance program for the poor. On Covered California, there will be federal tax credits to help people buy insurance. Individuals who make up to about $46,000 a year (or about $94,000 for a family of four) are eligible for the tax credits. People under 30 will also have the option of buying bare-bones, catastrophic plans with low premiums.
Still, getting young adults to buy insurance won’t be easy, Levitt warns. The financial penalty for not having coverage next year is fairly small -- $95 or one percent of income, whichever is greater. Also, fears abound that young people’s premiums will skyrocket because the health law limits the difference in price between plans for the young and old. And there's still just a lot of confusion about health reform.
“This generation has very low levels of insurance literacy," Tamika Butler tells me. She runs the Los Angeles-based chapter of Young Invincibles, a nonprofit advocacy group trying to get the word out about the health law’s benefits. Her group has launched a social mediaoutreach campaign and a mobile app that helps people find and rate cheap health care and answer questions about the Affordable Care Act. According to Butler, young adults are gateways to getting hard-to-reach minority communities insured.
“Young adults are really the leaders of their communities, of their families,” Butler said. “You see it when there's a young child translating for a parent at school, or helping them figure out a complicated financial aid form, and it’s the same for health care.”
Butler said it’s a misconception that most young people shun health insurance because they believe they’re indestructible. She says her groups’ polls and outreach activities have shown that the more young people learn about coverage, the more they want it.
Peter Lee who runs Covered California said the exchange is planning to launch a major media campaign aimed at young people this summer and to reach out to students on college campuses, at trade schools and those who work at low-wage jobs.
“We’ve been having focus groups, surveys and young people throughout California aren’t saying they don’t want to have health insurance,” Lee said. “They’re saying they can’t afford it, and they are looking for the security that health insurance provides.”
My brother David said he has felt a bit vulnerable without health coverage and will look into plans on the exchange.
“Just the other day I went ice skating," David said. “I went at the wall like full speed, and my skate edge slipped. I almost [went] face first into the wall, and at that point I was reminded that I don’t have health insurance.”
Covered California officials unveiled Thursday, a list of the health plans and rates they expect to offer on the exchange in October. The enrollment period will run through March 2014.