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 like Kpangbah were among the most significant beneficiaries of Obamacare, which helped reduce the number of uninsured millennials to record lows while also providing millions of Americans with free or low-cost insurance, maternity care, mental health coverage, and other services.
Now, Senate Republicans have proposed overhauling the Affordable Care Act, which could benefit some young adults by lowering the cost of their premiums in private insurance marketplaces but could harm others who gained coverage through a massive Medicaid expansion. According to a Congressional Budget Office analysis of the bill released on Monday, 22 million Americans could lose coverage under the Senate bill, which could change significantly before a vote scheduled for July 4.
In addition, the proposed legislation would keep a popular Obamacare provision that allowed young adults up to the age of 26 to remain on their parents’ insurance. However, many critics of the bill, including the American Medical Association and the American Hospital Association, believe that in its current form, it could significantly reduce health coverage and care for other young adults.
“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.”
One of Mishory’s main concerns is that states may opt out of requiring insurers to provide benefits such as maternity care, mental health coverage, and prescription drugs, all of which are commonly used by young adults. “You’ll see a lot of young people who aren’t getting the kind of coverage they require,” she predicted.
However, proposed changes to the marketplaces may make coverage more appealing to young people. According to the Congressional Budget Office, the Senate bill would result in a greater number of younger people paying lower premiums to purchase private plans. The proposal would allow insurers to charge older people up to five times as much as younger people, potentially resulting in lower premiums for younger people.
At the same time, the Senate bill changes the amount of money that people who qualify for subsidies must pay toward their own premiums, which means that people under the age of 40 may pay a smaller portion of their income toward coverage than they did under Obamacare.
However, because of higher deductibles and less assistance with out-of-pocket expenses, young adults may face additional cost increases. Some would no longer be eligible for subsidies because the bill would lower the eligibility income threshold.
Millions of young adults have enrolled in coverage through the insurance exchanges, thanks in part to a concerted effort to bring in as many healthy, young people as possible to balance out older, sicker consumers who were eager to sign up right away.
In 2017, approximately 27% of the 12.2 million consumers who enrolled in health insurance through the exchanges across the country were between the ages of 18 and 34. According to Covered California, the state’s insurance exchange, 37 percent of 2017 enrollees were in that age group.
Steven Orozco, a Los Angeles resident, is one of them. He, his wife, and their 2-year-old daughter have Covered California coverage. Orozco, a real estate agent, said they are all healthy and don’t need it often, but he keeps it on hand in case of broken arms or other unexpected medical needs.
Orozco, 32, expressed concern about what might happen in Washington and how it might affect his insurance, which currently costs around $450 per month.
Despite potential benefits for young adults in the private market, the Senate proposal would have the most negative consequences for young adults on Medicaid, according to Walter Zelman, chairman of the public health department at Cal State-Los Angeles.
In addition to phasing out Medicaid expansion, the Senate bill would reduce funding for the program, he said.
“The biggest impact on young people is the dismantling of Medicaid,” Zelman said.
According to Young Invincibles, since the implementation of the Affordable Care Act, approximately 3.8 million young adults have gained coverage through Medicaid expansion.
If the expansion is phased out, Zelman claims that hundreds of thousands of young people in California will be unable to access Medi-Cal, the state’s version of Medicaid. According to Zelman, who worked to enroll California State University students in Obamacare health coverage, young adults, low-income residents, part-time workers, and Latinos have historically had the highest percentages of uninsured people.
“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 Republican plan would result in more or fewer young people enrolling.
Sydney Muns, 27, of Sacramento, is uninsured because she works at a nonprofit that does not provide health insurance and earned too much money to qualify for Medi-Cal or Obamacare subsidies. Muns expressed hope that premiums and out-of-pocket costs will decrease in the future so that she can obtain 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.”
However, Chyneise Dailey, 24, stated that she intends to purchase health insurance whether or not she is required to do so. Dailey, who works at Sacramento State, is still covered by her parents’ Blue Cross health insurance plan, but she knows she only has a few years before she has to buy her own.
“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 stated. “I’d just rather be safe than sorry.”
Young women who seek reproductive health and other medical services from Planned Parenthood may suffer as a result of a provision in both the Senate and House plans to overhaul Obamacare that prohibits federal funding for the organization for a year.
That worries Niki Kangas, 35, who visits Planned Parenthood clinics despite having Kaiser Permanente job-based coverage. (Kaiser Health News, the company that produces California Healthline, is unrelated to Kaiser Permanente.) Kangas, of Sacramento, is “irritated” that the Senate’s proposed bill would impose a one-year ban on federal funding to the organization, which is a frequent target for conservatives.
“I’ve used Planned Parenthood a lot, either in between jobs or sometimes it’s just more convenient than going out to Kaiser, like if I just need birth control,” said Kangas, a project manager at a design agency. “I think for people who don’t have insurance through their work that it’s a resource they depend on.”
This report was contributed to by Mary Agnes Carey, Julie Appleby, and Barbara Feder Ostrov.
This story was produced by Kaiser Health News, which also publishes California Healthline, a non-profit editorial service of the California Health Care Foundation. Blue Shield of California Foundation contributes to KHN’s coverage in California.
Kaiser Health News (KHN) is a national news service covering health policy. It is a program of the Henry J. Kaiser Family Foundation that is editorially independent.