If the Supreme Court Rejects Health Care, I (And Millions Like Me) Am Screwed
Two years ago, on my 21st birthday, I reached two big milestones. The first was a gift — I was finally old enough to purchase some Merlot whenever I saw fit. The second was quite the penalty — I was too old to continue to receive health insurance from the government.
I was raised in a low-income, single-parent household, and so the lovely state of New Jersey had paid for my health insurance while I was growing up. In most states, government health programs stop covering individuals on their 19th birthday, but I guess I was fortunate enough to be born in such a gracious state that delayed my cut-off for two years.
Since then, I have often joked about not having health insurance to repress my anxiety (“Remember guys, if I get hurt doing this do not take me to the ER!”). People try to surprise me with good news: “Alyssa, did you know Obama’s Affordable Care Act allows people under 26 to stay on their parents’ health insurance?” I do know about the Act, but my mother’s health insurance doesn’t come with dependent coverage and the state dropped my coverage at 21.
Fortunately, I’m healthy right now. But it’s still nerve-racking to know that if I ever did need health care, I would either have to go without it or charge it on my credit card and hope I don’t end up like those who’ve had to declare bankruptcy — 62 percent of them due to medical expenses. While reading a new survey published this month, I was fascinated to learn that I was not alone.
The survey, published by the Commonwealth Fund, tracked health insurance among young adults. The survey, titled “Young, Uninsured, and in Debt: Why Young Adults Lack Health Insurance and How the Affordable Care Act is Helping,” found that two in five young adults (ages 19-29) did not have health insurance for all or part of the period between November 2010 and November 2011.
The study found that young adults from low-income households, like me, were most at risk of having a gap in their health insurance. In fact, 70 percent of young adults with incomes under 133 percent of the federal poverty level ($14,484 for a single person and $29,726 for a family of four) did not have health insurance for all or part of 2011.
Sara Collins, one of the authors of the study and vice president of the Commonwealth Fund, said the survey was conducted to learn more about the issue of young adults being uninsured.
“We know this is one of the most at-risk groups of not having health insurance coverage and so we’ve been tracking it over time,” she said.
Unsurprisingly, of those young adults who were uninsured, 60 percent said they didn’t get health care because they couldn’t afford it. I did a little research on the health care costs for myself, and the cheapest plan I found was a whopping $252 a month — and that was without dental, vision or accident coverage. Plus, with jobs hard to come by, paying for coverage is just not an option for me and many others. Indeed, 11 percent of young adults in the survey said they were unemployed but looking for work.
“It really reflects the way in which the health insurance system has been traditionally structured, which is that your likelihood of having coverage is really dependent on whether you have it offered through a job,” Collins said.
Those who dared to take care of their health found themselves in financial burdens. Fifty-one percent of uninsured young adults and 36 percent of all young adults reported problems paying medical bills or said they were paying off medical debt.
Among those, the survey reported:
43 percent said they had used up all their savings to pay their bills, 33 percent took on credit card debt, 32 percent had been unable to meet other debt obligations such as school loans or tuition payments, 31 percent delayed education or career plans, and 28 percent said they had been unable to pay for basic necessities like food or rent.
It may seem surprising that healthy, young people rack up costly health bills, but the truth is, we are not as healthy as many would like to think. In reality, 15 percent of young adults have one of these six chronic health conditions: arthritis, asthma, cancer, diabetes, heart disease and hypertension. And without preventive care, conditions worsen and medical costs increase. We also have the highest number of HIV diagnoses and women in our age group give birth to nearly 2 million babies a year. In addition, we have the highest rate of injury-related visits to emergency rooms. No matter how healthy you try to be, accidents do happen.
The report stated: “Young adults experience gaps in health insurance … at precisely the time they should be forming stronger links to the health care system and taking responsibility for their own care.”
The survey also revealed a race divide concerning coverage. While 54 percent of white young adults were covered under their parents’ health insurance, only 34 percent of black and 33 percent of Hispanic young adults were.
I know, by this point, you get it. Health insurance for young people right now is a big shit show.
Fortunately, the survey did illustrate how important the Act’s new young adult provision has been for the age group, while highlighting the need to implement the law’s remaining coverage terms over the next two years.
It is a shame that the young adult provision only covered those who were fortunate enough to have parents with health insurance policies that allow for dependent coverage. But the simple step of requiring insurance companies to keep dependent adults on their parents’ coverage or allowing them to join their parents’ coverage was fast and easy. (And, of course, fast and easy fixes are what our government does best.)
Collins said, “It was a way to extend coverage quickly to this age group.”
On the bright side, the survey found that of the 13.7 million young adults that stayed on or joined their parents’ health plans, 6.6 million would not have been able to do so without the Act.
“We are not sure we’ve ever seen so many young Americans obtain financial and health security in such a short period of time,” said Fabien Levy, press secretary for the U.S. Department of Health and Human Services. “Additionally, while there are still some Americans who are under- or uninsured, the goal of the Affordable Care Act is to provide all Americans with good, reliable health coverage by 2014.”
Although our healthcare structure will not be single-payer, it will cover up to 34 million uninsured Americans within the next decade, bringing the total insured population to 92 percent in 2021. Beginning in 2014, the Act will expand the eligibility for Medicaid as well as subsidize private health plans for those with incomes up to 400 percent of the federal poverty level ($43,560 for a single person or $89,400 for a family of four). According to the Commonwealth Fund, “these provisions will provide near-universal coverage for this age group.”
That is, if the Supreme Court doesn’t find the Affordable Care Act to be unconstitutional. Next week, the Court plans to vote on the Act to determine the constitutionality of the law’s mandate. The mandate requires individuals who do not receive health insurance from their employers or the government to purchase it from private insurance companies or pay a fine.
When the law was passed in 2010, 26 states challenged the mandate, claiming it infringed upon individual liberties. This argument, which was concocted by a few conservative thinkers despite it having little basis in existing law, made it all the way to the Supreme Court, which now may strike down the mandate or the entire law.
The Supreme Court will announce its decision any day now. My future health and that of many others will be on the line.
Yet, even if they quit their judicial activism and reach the proper conclusion, I still have to wait until 2014 for health care, and so these will be a careful next two years. Hopefully, all the alleged health benefits of red wine are true.