The Patient Protection and Affordable Care Act (PPACA) of 2010 was signed into law on March 23, 2010 (HHS.gov., 2015). Referred to as the Affordable Care Act (ACA), it is a health reform effort that has generated a great deal of controversy due to its complexity and wide range of impact. The ACA is mainly concerned with mandating that every person in the country have some form of health insurance. Almost immediately after the legislation was passed, marketplaces for health insurance appeared and businesses hurried to find coverage for employees. There were some very negative changes that resulted such as higher premiums or cancelled coverage, but statistical effects show that the ACA has made impressive gains toward improving health care for the American public.
There is a myth that young people don’t need health insurance due to being a low risk population. However, at this stage of their lives, young adults battle obesity, drug and tobacco use, sexually transmitted diseases, and accidents from irresponsible behavior. Data from a Commonwealth Fund Biennial Health Insurance Survey (2007) showed that individuals aged 24 years and older paid approximately the same rates as senior citizens: 78 percent versus 84 percent. However, the ACA has promoted expansion of the Medicaid coverage to any person under the age of 65 who meets income guidelines; as of January 2016, only 19 states are not expanding Medicaid in this manner. For example, the income cutoff is $27,724 for a family of three in 2015. In states not expanding, the cutoff is $8840 and childless adults are not eligible. For this reason, many young adults are trapped between earning too much money to qualify for Medicaid and not earning enough for Marketplace tax credits.
In the past, young adults have been shown to be less likely than teenagers or seniors to have health insurance (Cohen and Bloom, 2008). Rather than using primary care providers, young adults have been shown to opt for medical provision from emergency rooms for care (Cohen & Bloom, 2008). One of the improvements for coverage has been extending the ability to be on their parents’ insurance plan until the age of 26 regardless of marital status, living with their parents or not, or whether they are a dependent on income tax filing (Collins & Nicholson, 2010). More than three million young adults have obtained health insurance coverage from this change (Sommers & Kronick, 2012). Data from 2011 demonstrates that as soon as extended dependent coverage took effect, there were significant increases in the amount of preventive and routine care by young adults and fewer numbers allowing medical needs to proceed until costs were increased (Sommers, Buchmueller, Decker, Carey & Kronick, 2012). When young adults run the risk of having health care exposed to their parents of a sensitive nature, they will often postpone or avoid treatment. There are few laws governing confidentially of young adults and these are at the state level. Billing and claims processes for insurance companies require amending in order to allow young adults to accept responsibility for their health in the areas of reproduction and sexuality.
A report by Furman (2014) on the analysis conducted by the Congressional Budget Office (CBO) concerning the ACA on labor stated the provision of financial security for families in the United States was improved by allowing protection against high health care costs by providing affordable insurance. The CBO stated that 2 million people had obtained coverage in the insurance marketplace in addition to receiving tax credits; the number was 8 million in 2014 and was projected to rise to 11 million in 2015. With decreases in employee health care coverage, businesses had more cash assets to hire additional workers and provision of health care coverage resulted in fewer sick days. The impact on young adults with these changes is more available employment; in addition, previously they were locked into inadequately paying jobs for the insurance and now have the freedom to look for higher payment careers.
However, the ISIhr (2014) released a contradictory report stating that the CBO analysis did not mention that 2.5 million jobs were eliminated as a consequence of the ACA. Employees did not have to work as many hours for the same income and dropped to part-time status following dependence on employer insurance. In addition, since businesses are mandated to provide employee insurance to anyone working over 30 hours per week, they cut scheduled hours to avoid the requirement. This may have prompted young people who did not have the option of being on parental insurance to have to take on a second job.
An important aspect of health care coverage for young adults is that they are able to obtain services for sexual and reproductive medical needs such as screenings for sexually transmitted diseases or birth control. However, there are some issues with lack of confidentiality by insurance billing practices listing treatments on statements, allowing parental access to the information. The purpose is to prevent fraud and promote transparency in the insurance industry, but when young people access care through their parents’ plan, their confidentiality is threatened.
Discussion
Young adults have been provided new options for obtaining health insurance under the ACA. This paper has focused on the changes occurring since the implementation of the law in 2010 as coverage was extended on parental policies to age26, but additional influences by the health insurance marketplaces will probably continue to affect health care for this population. By monitoring the changes that occur in primary care for young adults, including preventative care and their choice of health care providers, it will be possible for the industry to provide optimum services for the country’s future workforce.
It is necessary to continue analysis through the end of the fiscal year 2019 in order to realize the full impact of the ACA on young adults. The Democratic president that signed the law into effect is ending his term and it is expected that the administration that replaces President Obama will make changes in the ACA in reaction to the negative opinions held by the vocal public. The changes made will change the predictions of affect and at that point, new research will be needed.
But as of today in 2016, the answer to the question of whether the Affordable Care Act of 2010 supports the needs of young adults for health care is “yes”. The government has created a way for health insurance carriers to operating in a common marketplace and record numbers of young adults are not only obtaining health insurance, but receiving medical care previously too costly for them to afford.
References
Berwick, D. (2011). Impact of the Affordable Care Act on Seniors and Medicare. Hhs.gov.
Retrieved 28 March 2016, from
http://www.hhs.gov/asl/testify/2011/02/t20110210a.html
Cohen, R., & Bloom, B. (2010). Access to and Utilization of Medical Care for Young Adults
Aged 20–29 Years: United States, 2008 (pp. 1-8). Hyattsville, MD: National Center for
Health Statistics. Retrieved from http://www.cdc.gov/nchs/data/databriefs/db29.PDF
Furman, J. (2014). Six Economic Benefits of the Affordable Care Act. The White House.
Retrieved 28 March 2016, from http://www.whitehouse.gov/blog/2014/02/06/six- economic-benefits-affordable-care-act
HHS.gov. (2015). Read the Law. HHS.gov. Retrieved 30 March 2016, from
http://www.hhs.gov/healthcare/about-the-law/read-the-law/index.html
ISIhr. (2014). The Economic Impact of Obamacare - ISIhr. Retrieved 28 March 2016, from
http://isihr.com/health-reform/economic-impact-obamacare/
Koh, H., & Sebelius, K. (2010). Promoting Prevention through the Affordable Care Act. New
England Journal of Medicine, 363(14), 1296-1299. doi:10.1056/nejmp1008560
Sommers, B., Buchmueller, T., Decker, S., Carey, C., & Kronick, R. (2012). The Affordable
Care Act Has Led To Significant Gains in Health Insurance and Access To Care For
Young Adults. Health Affairs, 32(1), 165-174.
http://dx.doi.org/10.1377/hlthaff.2012.0552
Sommers, B., & Kronick, R. (2012). The Affordable Care Act and Insurance Coverage for
Young Adults. JAMA, 307(9). http://dx.doi.org/10.1001/jama.307.9.913
Spear, S., & English, A. (2007). Protecting confidentiality to safeguard adolescents' health:
finding common ground. Contraception, 76(2), 73-76.
http://dx.doi.org/10.1016/j.contraception.2007.04.011
