The ACA's Future

Jul 21, 2014
B. Rose Huber | (609) 258-0157
Woodrow Wilson School

A report released by the Congressional Budget Office predicts that the number of people with health insurance bought via the Affordable Care Act (ACA) will more than double next year, reaching 13 million, and then double again by 2016, reaching 24 million.

Despite technical issues during the ACA's onset, young adults came out in droves to sign up for health insurance via Obamacare. What does this movement showcase in terms of individualism? And how many young people are choosing to take health insurance into their own hands?

We sat down with health historian Keith Wailoo, vice dean of the Woodrow Wilson School of Public and International Affairs and affiliate of the Center for Health and Wellbeing (CHW), and Wilson School lecturer Heather Howard, director of the State Health Reform Assistance Network, based at CHW, to discuss the latest ACA figures and what this means for health care in America.

Q. Have we seen a rise in the number of young people with health care insurance thanks to the ACA?

Howard: Yes, without question. The ACA makes health insurance more accessible and more affordable for everyone, especially young people.

Q. What is the breakdown in terms of young people who are still on their parents' insurance versus those who have individual plans?

Howard: The ACA allows young adults to stay on their parents' insurance plans through age 26. How many have already done so? Exact numbers are hard to pin down, but experts believe that the answer sits somewhere in the range of 1-3 million young people.

Also thanks to the ACA, many young people can now purchase subsidized coverage on their own. During the first open enrollment period, more than two million individuals ages 18-34 enrolled in private plans through the new exchanges, with the majority receiving financial assistance.

In addition, many young people went shopping outside of the exchanges, at other online insurance portals. One web broker estimated that 45 percent of its new enrollees in ACA plans were between 18 and 34 years old.

Q. With this rise in the number of young people signing up for health insurance, how has the landscape changed? Are these individuals now more independent?

Wailoo: In the last eight months, millions of new beneficiaries have become modern health care “consumers.”  Instead of heading to the emergency room when they or family members become sick, they have had to become familiar with the privileges, benefits and annoyances of American health care consumerism. For the first time, they have figured out their coverage eligibility and what plans they could afford. They’ve had to ante up their first insurance premiums and dig into their pocketbooks for co-pays. They’ve had to spend time thinking about their health needs and the many frustrations involved in dealing with insurance companies and plans. 

Fortunately or not, this is part of what “taking personal responsibility” for one’s health care looks like in the 21st century United States.

Q. Would you say there is no longer a fear of the ACA failing because enough young people have signed on to keep the momentum going?

Howard: There was a fear that young people – sometimes called “young invincibles” – would not purchase insurance, thinking they didn’t need it. But in the end, we saw that young people did recognize the value of health insurance in providing financial protection, in addition to access to health care, and millions of them ultimately signed up for coverage. We expect states to do even more effective outreach to young people this fall, learning from what worked in the first year. (Princeton’s State Health Reform Assistance Network collects and disseminates best practices in consumer assistance and enrollment.) So far, the ACA is working.

Q. While it may be too early to say how the ACA will change America, could you offer any speculations?

Wailoo: Beyond partisan politics where health is too often caricatured as an issue of government dependence versus personal responsibility, the ACA's implementation has seen the false dichotomy between dependence and responsibility begin to fall apart. What we are beginning to witness is a sea change in health education, health literacy, and health responsibility. Whether it will be comparable to how other major national initiatives (from the War on Cancer to Medicare) slowly reshaped the health beliefs, priorities and practices of earlier generations, only time and continued diligence will determine.

The truth about personal responsibility in health care is that you can’t get there all alone and without help – that is, without an employer who offers health coverage, or (now) without government giving you the basic means to become a modern-day consumer.

Q. In general, how are our views about health care shaped? What does the ACA have to offer, and how might it change our views?

Wailoo: It doesn't come out of nowhere. Our views about the role of individual initiative and how we should be taken care of are things that are nurtured and developed in childhood, and our parents also went through that process. Rather than thinking about health as something that is individualized, it's useful to think about it as moving through generations – one generation handing to another a set of expectations that I, as an adult, have to rethink and revise as I look to my own children and what expectations I'll have for them …

The ACA experiment has a lot to offer to both those who champion individual responsibility and for those who sing the praises of big government. In reality, it offers a new generation of people the possibility of “taking responsibility” and “ownership” for their health, a virtue Republicans strongly endorsed, but it does so through big government. 

For a more in-depth look at how we define health, be sure to watch "A Historian Looks Ahead," which featured an interview with Wailoo and was produced by the Robert Wood Johnson Foundation.

WWS Reacts is a series of interviews with Woodrow Wilson School experts addressing current events.