This Saturday is National Youth Enrollment Day, a day of action to educate young adults on the importance of having health insurance. Celebrities like Amy Poehler (above), are helping to get the word out and the Young Invincibles campaign is encouraging people to share the message to friends and networks. Young adults between 19 and 34 have disproportionately high uninsured rates – those 19-29 have the highest rate in the country, representing over a third of the uninsured population. They also tend to be healthier than older adults. (Which doesn’t mean they (we) don’t want and need health insurance!)
Because this group tends to be healthy, there has been a lot of talk about so-called “Young Invincibles” and the way enrollment rates among these young adults may impact the overall success of the Health Insurance Marketplaces. The logic goes that if more healthy, young adults enroll in Marketplace plans, this will subsidize the older and sicker population that enrolls. With too many sick enrollees, experts expect to see higher insurance rates. As of the end of December, about 1/4 of enrollees around the nation were young adults – 26% in New York. Some have questioned whether these numbers are high enough to protect the risk pools, while others have pointed out that many young adults are likely to wait until later in the enrollment period to sign up. There is also controversy about whether “young adults” should really be the focus – in fact, the Commonwealth Fund just released a new report on the subject, arguing that it is the health status of the insured pool, not age, that really makes the difference.
We do know that thousands of New Yorkers between 19 and 35 have already signed up and are benefiting from the new, more affordable options available to them. Take Tamika G., a 26-year-old from Brooklyn who will now pay $135/month for insurance that gives her peace of mind and access to the services she needs. Tamika was eligible for financial assistance in the form of tax credits and cost-saving reductions – these reduced her monthly premium and lowered her other out-of-pocket costs. For many young adults who have struggled to afford insurance in the past, this financial assistance will make the dream of being covered a reality.
Now that she’s insured, Tamika is ready to share the love:
“I’m going to tell my friends as soon as I get home that this is the way to go. You don’t want to break your arm and worry about how you’re going to pay for it.”
Out of all of the attention on young adult enrollment, this is the message that should stand out: Health insurance is for all of us, young adults included. Now that we have our chance to finally have the affordable, quality coverage we deserve, let’s take it – and make sure our friends do, too.
Left: Adora Campis (red hat) with parade participants at the annual Three King’s Day parade in Harlem; Right: Adora and Maryanne Tomazic of Raising Women’s Voices – NY at HCFANY’s Annual Meeting Thursday, January 9.
Guest post: Lois Uttley, Director, MergerWatch Project/Raising Women’s Voices-NY
Adora Campis is a part-time bilingual (English and Spanish) outreach worker for Raising Women’s Voices-NY. She will go pretty much anywhere to find uninsured women and families and tell them about the new health coverage options available through NY State of Health, New York’s Marketplace!
Last Monday, she joined the annual Three King’s Day parade through East Harlem to talk to uninsured people along the route in this neighborhood with many low-income, Spanish-speaking people. (She’s in the red hat in the photo left, above). Later in the week , she spoke at HCFANY’s annual meeting in Albany about why she is so passionate about her work.
Here is her story:
I’m sure you want to know about the faces of the uninsured that I have met in New York City. This much I know. From a homeless person at a soup kitchen starving for medical care, to a degree-holding woman facing loss of coverage and having to pay too much for COBRA – they want and are eager for affordable health care.
The timing is right. The uninsured are diverse and come from all walks of life. Some of them are people in between jobs, others are at jobs that have no health benefits. Some are recent college graduates, others are new citizens. Some have young kids, others are still kids themselves.
Sometimes they are people like me. I am a single mother and raised two children on my own. My son unexpectedly needed health care while he was in college. Luckily he had health insurance. It wasn’t the best, so we still got a $1,000 bill. But there was peace of mind knowing that he was able to get the care he needed.
I didn’t have health insurance though. Last year, I had worked for a couple organizations part-time, but still couldn’t afford to buy health care coverage on my own. Because New York decided to expand Medicaid eligibility this year, I was able to enroll in health insurance through NY State of Health and now am covered.
That’s what I love about going into the community to talk about these new changes. I know it works. It can be scary approaching strangers at community events to talk about health reform, but I’ve found that everyone is very passionate about this. They have personal, sometimes painful stories. But they all end in the fact that this change couldn’t be any more timely. People welcome it!
The Governor’s proposed 2013-2014 Executive Budget aims to get rid of New York’s Family Health Plus (FHP) program by closing off enrollment by the end of this year. Enrollees who earn below 138% of FPL (about $26,000 per year for a family of three) will get the current Medicaid benefit (with the exception of long-term care). Parents up to 150% of FPL (about $28,000 for a family of three) will get subsidized coverage on the forthcoming Exchange.
However, eligible folks who aren’t able to enroll by the cutoff date, or whose income shifts into the eligible range after the cutoff date will be out of luck. These folks will have to look for affordable coverage on the Exchange.
The Exchange will provide premium tax credits to help lower the cost of insurance for most low- and moderate-income folks who purchase coverage on the Exchange. But, it will still be too expensive for many families. For example, a family of three earning 150% of FPL will still have to come up woth $1,099 per year on their own for coverage on the Exchange whereas the same family would have gotten free coverage with very low cost-sharing through FHP.
But there is a solution to this affordability problem.
First, we ask the State to apply for an 1115 waiver – similar to those being pursued by Massachusetts and Vermont – to provide an affordability wrap for premiums and cost sharing for folks up to 200% of FPL not eligible for Medicaid. This would help to get out-of-pocket costs on the Exchange down as close as possible to FHP levels. If NY can’t get federal matching funds, the State should earmark a portion of the $2.5 billion in State Medicaid savings under the ACA for this.
Next, New York should lay the foundation for a Basic Health Plan (BHP) by authorizing establishment of this program starting in 2015. The ACA gives states the option of creating a federally-funded BHP to cover adults up to 200% of FPL not eligible for Medicaid. This program would result in State savings of between $500 million and $1 billion each year.
This is a big opportunity for State lawmakers to ensure affordable coverage is available to the individuals and families who need it most. And, when federal funds or state savings are factored in, it would require little or no additional cost to the State.
Quite simply, it’s the right thing to do.
Under the ACA, states are allowed the option of creating a Basic Health Plan (BHP) for low-income adults who earn too much to qualify for Medicaid. Ordinarily, if these folks don’t have employer-sponsored coverage then come 2014 they will be able to buy insurance through the Exchange with the help of federal tax credits. But, even with the tax credits this coverage may still be too expensive for them. The BHP then would act as a bridge between the free or low-cost Medicaid coverage and the higher priced options available on the Exchange.
Don’t be fooled by the name though - there is nothing “basic” about it. According to the ACA, BHP coverage must be as affordable and comprehensive as what these adults would have gotten on the Exchange. In New York, coverage would likely resemble that of the Family Health Plus program.
New York currently offers public coverage to low-income adults through its Family Health Plus program, the cost of which is split with the federal government. New York also pays for Medicaid coverage for low-income immigrants without help from the federal government. Through the BHP program, New York would be able to cover both of these groups and have the federal government pay for it all. This would save the state between $500 million and $1 billion per year.
Sounds great, right? Problem is, the federal government still hasn’t released guidance on this program, and isn’t planning on doing so anytime soon. Unfortunately, state policymakers won’t commit to the program until they are sure of all the details. So, until that happens, it is unlikely that New York will get any of the cost-savings and affordability protections that the BHP has to offer.
HCFANY has created a policy brief on this issue to explain it in detail, urge federal policymakers to release BHP guidance, and provide recommendations to state policymakers.
Click here to read HCFANY’s policy brief, titled “The Basic Health Program Option in the Affordable Care Act.”