August 8 2014
Patrice J. Lee
First Lady Michelle Obama called young people knuckleheads earlier this year on the Tonight Show with Jimmy Fallon. According to her, when we get out on our own we think we’re invincible which opens us up to disaster if we have no insurance. After all we like to dance on bar stools and are cooking for the first time so we’re prone to slice our fingers open. If only I was making this up.
This description of my generation by our nation’s leading lady is insulting and a misreading of why many young people have passed on ObamaCare.
In fact, it comes down to numbers. For many young people, not only is ObamaCare too expensive, it eliminated cheaper, private options that young people would otherwise have obtained even with taxpayer-funded subsidies.
Millennials are not a monolithic group; we differ in stages of our career and income brackets. While some are still in college, others are years into their career and pulling down good paychecks. Forbes dissected our generation into three slices and examined the incentives and unintended consequences that the un-Affordable Care Act introduced into the healthcare decisions of Millennials.
What they find is that Obamacare actually creates a perverse incentive for a third of 24-year-olds to become or remain uninsured. Those 24-year-olds with incomes at 275 percent (up to as much as 400 percent) of poverty will qualify for little or no subsidy and the lowest cost plans on ObamaCare carry premiums that are too high to be considered “affordable.”
Furthermore, before ObamaCare this group would have been better off buying a simpler plan, but ObamaCare got rid of those plans. (There are examples from last fall of historically black colleges and community colleges whose barebones plans were eliminated because they weren't ACA compliant.) So it’s financially smarter to pass on healthcare coverage for many young people and they’ll pay the individual mandate penalty instead. (To be clear, carrying healthcare coverage is a responsible decision that we hope each person makes.)
Very low income 24-year-olds with incomes close to poverty clearly have a strong incentive to secure coverage because subsidies on the Exchanges drive the net cost of coverage (inclusive of out-of-pocket spending) well below the expected costs of being uninsured or of the expected costs of a non-qualified plan outside the Exchanges.
For young adults at 225% of poverty, it’s much more of a toss-up. The expected annual costs (inclusive of the individual mandate penalty) is about the same whether such an individual remains uninsured, buys a non-qualified plan or obtains subsidized coverage.
About 30% of 24-year-olds have incomes at 275% or more of poverty. The chart demonstrates starkly how Obamacare makes life worse for such individuals. Prior to Obamacare, such individuals would have been slightly better off buying a non-qualified health plan with an actuarial value of 50%. But Obamacare gets rid of such plans, substituting plans with a higher actuarial value and more comprehensive benefits.
Millennials like their parents and grandparents make calculated decisions about how to spend their resources. And those resources are not unlimited. Young people have less wealth than retirees and Baby Boomers. They are therefore, extremely price conscious. If there was no subsidy to help defray costs, it would be a surprise if any (other than those who qualify for Medicaid) would even purchase coverage through ObamaCare. The Administration is keenly aware of that—which is why they will fight to ensure that taxpayer subsidies remain.
The story on ObamaCare is far from over. In fact, it’s just beginning. What we did not need was another government subsidy and program that distorts the healthcare market. We need are actual reforms that, as Forbes notes, should be “more efficient, equitable and effective.”