Access to Care Report/This Week (#5): Why will young adults sign up — or not sign up — for health insurance under the ACA?
August 8, 2013
The question of whether or not young adults will sign up for health insurance is an important one for the Affordable Care Act (ACA)—and an issue that can provide significant insight to attorneys.
Access to health insurance depends on whether an individual chooses to seek such coverage, and whether coverage is available under reasonable terms when sought. Both of these aspects of insurance are on clear display as the new Health Exchanges attempt to encourage young adults to sign up for health insurance through the marketplaces that are being put in place.
The ACA statutes include an individual mandate to discourage going without insurance, while competitive premiums and subsidies encourage people to enroll. But an unknown at this time is whether individuals will choose to pay a minimal penalty (of $95 for 2014), purchase insurance, or do nothing (ignore the ACA and refuse to deal with it).
There is a major debate raging in the media as to whether or not young adults will sign up for health insurance through the Exchanges. It is not clear how much effect will be noted from messaging about the advantages of enrollment. This outcome will directly determine the impact of the ACA on access to care.
In order to hold premium costs down to an acceptable level, applications for coverage from older and sicker applicants need to be balanced out by applications from younger and healthier applicants.
Enrollment is open to everyone despite health status or preexisting conditions, and older and sicker individuals may be motivated to sign up. The question is whether young and healthy individuals will enroll in sufficient numbers to hold down average costs.
Critics of the ACA forecast doom, that young adults will not enroll—because it is not cost-effective for them. Supporters of the Plan believe that with a little encouragement, young adults will choose to enroll to protect themselves—and their families—against unexpected accidents and illnesses.
Beginning enrollment in a few months will constitute a test of which perspective is correct. Very soon, more information will be available on decision making by young adults, as affected by positive and negative media drives.
Amazingly little effort is being put forth to understand how and why these choices will be made, and to evaluate the significance of the outcome.
It would be good to keep track of all the efforts to shape enrollment—and to consider the impact of various messages on target groups. Contemporaneous data could be collected to draw conclusions about how young adults view the world and decide to spend money.
Perhaps efforts should be put in place to better understand this behavior.
Perhaps media appeals to young adults should emphasize the protecting of families and close friends, not self-protection. Or perhaps the emphasis should be on doing the “right thing” out of duty or obligation. Or perhaps emphasis should be on signing up as the socially-acceptable thing to do—as “cool”.
There is a certain sterility about the present attacks based on cost-effectiveness and dollars as the only motivators.
What does this have to do with attorneys?
First, understanding motivation is an important aspect of representing clients.
And understanding the mechanisms underlying access to health care is important when attorneys assist clients in obtaining the care that they need.
Previous installments of “Access to Care Reports” address the various ways in which access to care issues are affecting legal practices: