‘Young Invincibles’ create a headache for ACA enrollment goals

Joanne Kenen

About Joanne Kenen

Joanne Kenen, (@JoanneKenen) the health editor at Politico, is AHCJ’s topic leader on health reform and curates related material at healthjournalism.org. She welcomes questions and suggestions on health reform resources and tip sheets at joanne@healthjournalism.org. Follow her on Facebook.

Photo: Sam Antonio Photography via Flickr

Photo: Sam Antonio Photography via Flickr

The “Young Invincibles” are back in the news.

The Obama administration expected – and needed – large numbers of younger and healthier people to sign up for coverage under the Affordable Care Act to have a sustainable risk pool. However, it hasn’t happened, at least not in the numbers needed.

In fact, of the roughly 27 million people who remain uninsured, despite all the coverage gains under the ACA, more than one in four are under age 30, and about 68 percent have low health risks, according to McKinsey & Co. data provided by the U.S. Department of Health and Human Services.

Kimberly Leonard, a health reporter at U.S. News & World Report and the co-chairperson of the Washington, D.C. chapter of AHCJ, has created a tip sheet to help you understand why this demographic has been reluctant to sign up. Plus the steps that the administration plans to change that for the 2017 enrollment season that begins Nov. 1.

Leonard looks at who comprises these “young invincibles,” where they can get covered (including staying on their parents’ plan until age 26) and why they often opt to remain uncovered. She also discusses the role of ACA mandate penalties; how Medicaid expansion affects this age group and what tech tools the administration and its allies plan to deploy.

2 thoughts on “‘Young Invincibles’ create a headache for ACA enrollment goals

  1. Norman Bauman

    Where did this phrase “young invincibles” come from?

    It sounds pejorative, and blames consumers for not making the decisions that the ACA economists predicted they would make and thought they should make.

    Another explanation is that the ACA is economically a bad deal, they recognize that, and they are making rational decisions. Even with the subsidies, they can’t afford the premiums, and if they could, they couldn’t afford the the deductibles and copays.

    The AHCJ NYC chapter had a press briefing on the ACA, and they gave us an example of “Angie from Queens,” who was a 27-year-old art director making $27,000 a year. At one price point, her premiums would cost about one month’s salary ($2,250) a year, she wouldn’t be able to use it until she paid a large deductible, and then she would have large copayments. She could pay as much as $8,500 total premiums and out-of-pocket. For a 27-year-old who is paying college loans, and metropolitan rents, this seems unaffordable.

    Trudy Lieberman gave many more stories of people in this situation in her CJR coverage http://www.cjr.org/author/trudy-lieberman-1/ and in her Harper’s story http://harpers.org/archive/2015/07/wrong-prescription/

    The problem with Obamacare was that it was unaffordable (as Robert Kuttner explained in the NEJM and elsewhere). They addressed this problem by naming it “the Affordable Care Act.” One of the ways to make the numbers come out was to “incentivize” younger patients to make an economically irrational decision to buy insurance that would actuarially cost them more than it would pay out, in order to subsidize older patients. Instead, they’re making economically rational decisions. To explain why this solution failed, the policy makers are claiming that young people are rejecting Obamacare because they believe they will never get sick. Actually, they’re rejecting Obamacare because it’s a bad deal (and they can’t afford it).

    P.S. After I wrote this I found somebody who explained it better than I did, and tells me where the phrase came from:

    Five myths about ‘young invincibles’
    By Sarah Kliff
    Washington Post
    November 26, 2013

    “Coined by the health insurance industry, the term “young invincibles” has come to describe 18-to-34-year-olds who go without coverage because they expect to remain healthy.”

    (But, Kliff says, this isn’t true.)

    “To make the math work — and to cover the medical bills of older, sicker enrollees — insurers have often had to raise rates for young adults.”

  2. Norman Bauman

    After I wrote this I found the Kaiser Health Insurance Marketplace Calculator http://kff.org/interactive/subsidy-calculator/ and ran the numbers for Angie from Queens for the silver plan in 2017 http://kff.org/interactive/subsidy-calculator/?state=ny&zip=&income-type=dollars&income=27000&employer-coverage=0&people=1&alternate-plan-family=individual&adult-count=1&child-count=0&child-tobacco=0#state=ny&zip=11101&income-type=dollars&income=27000&employer-coverage=0&people=1&alternate-plan-family=individual&adult-count=0&child-count=0&child-tobacco=0 and I got slightly different results.

    With the subsidies, Angie would wind up paying $167/month, or $1,998/year, which is a little better. However, out of pocket limits are $11,400, or a total of $13,398, and someone with a chronic disease could easily reach that with the new biological drugs. How can anyone afford $13,398 on an income of $27,000 a year?

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