Open enrollment in the Affordable Care Act (ACA) marketplaces ends this Friday in the 39 states that use HealthCare.gov. Based on past open enrollment periods, the deadline may trigger a surge in marketplace visitors this week. Many of these last-minute enrollees will be young adults ages 19–34.
| Ten states have extended their sign-up periods. | |
| California | January 31 |
| Colorado | January 12 |
| Connecticut | December 22 |
| D.C. | January 31 |
| Maryland | December 22 |
| Massachusetts | January 23 |
| Minnesota | January 14 |
| New York | January 31 |
| Rhode Island | December 31 |
| Washington | January 15 |
Young adults have made the largest gains in insurance coverage of any age group since the ACA went into effect, according to Commonwealth Fund and federal surveys. The Commonwealth Fund’s Affordable Care Act Tracking Survey and Biennial Health Insurance Survey also found this new coverage is making it possible for young adults to afford and receive health care. Yet the much shorter open enrollment period for the marketplaces this year — along with the tax bill’s repeal of the individual mandate penalties — could erode coverage among young adults of all income levels.
Young Adults Have Made the Largest Gains in Insurance Coverage
Prior to the ACA, young adults were uninsured at higher rates than the rest of the working-age adult population. In 2013, before the ACA marketplaces opened, more than one-quarter of 19-34-year-olds were uninsured. Young adults often lost coverage they had through a parent’s plan or Medicaid on their 19th birthdays. College graduation was another coverage break point for many young adults.
Several provisions in the ACA — including subsidized private insurance in the marketplaces, expanded eligibility for Medicaid, and the option to stay on a parent’s health plan until the age of 26 — were aimed at ensuring young adults wouldn’t lose their health insurance when they hit certain life milestones. By 2017, the uninsured rate among young adults dropped to 16 percent.
Young black and Latino adults have made the greatest coverage gains — 15 and 17 percentage-point declines by 2016 respectively — since the law was signed in 2010.
Medicaid Expansion Particularly Helpful for Young Adults
Young adults have comprised a disproportionate share of enrollment in the Medicaid coverage expansion, which enables states to cover adults up to 133 percent of the poverty level, or about $16,000 a year. This is not surprising given that the largest share of uninsured young adults prior to the ACA were in lower- and moderate-income households. Young adults made up 34 percent of the adult population but 41 percent of Medicaid enrollment in 2017.
A Majority of Young Adults Are Able to Access and Afford Care
The ACA Tracking Survey asked young adults if they used their new marketplace or Medicaid coverage to visit a doctor, hospital, or other health care provider, or to pay for prescription drugs. More than three-quarters (77%) reported using their coverage. Of those, 61 percent reported not being able to access or afford their care prior to obtaining it.
Young adults’ expanded access to health insurance has helped them get the care they need. In 2012, our biennial health insurance survey found 29 million young adults, or 48 percent of those surveyed, reported they did not get needed care in the past 12 months because of cost. By 2016 this number had significantly declined to 21 million, or 33 percent— the lowest rate since the measure was added to the survey in 2003.
Since the passage of the ACA, the overwhelming majority of young adults have been satisfied with their marketplace or Medicaid coverage. In 2017, 94 percent of young adults reported being somewhat or very satisfied.
Policy Implications
The ACA’s coverage expansions have enabled millions of young adults to access health insurance through their parent’s plans, the marketplaces, and Medicaid. But 16 percent of young adults remain uninsured. Given the large role that Medicaid has played in coverage for this age group, expanding Medicaid in the 19 remaining states would lead to gains.
Along with Trump Administration actions affecting the marketplaces, such as the shorter open enrollment period for 2018, the repeal of the individual mandate penalties under congressional Republicans’ tax bill could trigger coverage losses among young adults. These changes have the potential to reverse gains in access and reductions in medical bill problems seen in this age group over the last four years. And the loss of a healthier group of enrollees will also mean higher costs and fewer plans for those across the age spectrum who continue to buy coverage in the marketplaces.
