When the Affordable Care Act (ACA) passed in 2010, one of the biggest unknowns was this: Would enough young, healthier Americans sign up for Obamacare to keep the fledgling health insurance marketplace viable?
“Young invincibles,” many believed, were critical for balancing out the older, sicker – and more expensive – enrollees who would otherwise dominate the market. Without enough younger participants, experts feared, the market would see a “death spiral” of rising premiums that could lead to its eventual collapse.
But since 2010, more than 5.7 million young Americans ages 19-to-25 have gained coverage, according to government figures, including significant numbers of African-Americans, Latinos and other minorities. And of the 8.84 million Americans who chose a plan during the most recent open enrollment period, 28 percent were millennials ages 18-to-34. These figures are all the more remarkable given that in 2010, the uninsured rate among 19-to-25 year olds was 34.1 percent – more than double the uninsured rate among the population as a whole.
How is Obamacare winning millennials?
For one thing, many young Americans actually want coverage – “young invincibles” turns out to be a misnomer. A 2013 survey by Kaiser, for example, found that among adults ages 18-25, only 11 percent said they were “healthy enough that I don’t really need insurance,” and that 77 percent believed it to be “very important personally” that they have insurance.
What was holding young Americans back from getting coverage was something else: Cost. Or rather, perceptions of cost.
“It’s not because there aren’t affordable options available,” says Sophie Stern, director of best practices at Enroll America, a nonprofit that’s leading a national campaign to promote enrollment under the ACA.
Enroll America found, for example, that fewer than half of young Americans were aware of the coverage subsidies available under Obamacare, and that fewer than 3 in 10 were aware that most preventive services are now free. The Kaiser survey, meanwhile, found that 65 percent of young Americans were worried about “not being able to pay medical bills for a serious illness or accident,” and that 44 percent worried about meeting bills for routine health care.
Two factors are now turning the tide, which accounts for growing interest and enrollment by young Americans in Obamacare.
The first is policy. Under the ACA, a provision allowing children to stay on a parent’s plan until age 26 has helped 2.3 million young Americans gain coverage, according to the Department of Health and Human Services.
A second – and perhaps more significant – factor is a public education and marketing campaign unmatched in any other social program in modern times. Led by Enroll America, more than 4,600 organizations nationwide have worked in a concerted effort to promote enrollment under the ACA, including especially among the young.
Through its Get Covered America campaign, Enroll America and its partners – which includes nonprofits such as the United Way and the NAACP and companies such as CVS Caremark and Aetna – reported reaching 6 million Americans during the last open enrollment period. In part due to their efforts, 3.4 million Americans ages 19 to 25 signed up for coverage between October 2013 and March 2015.
What’s been working for millennials, says Enroll America’s Stern, is “trying to meet them where they are” to spread the word about Obamacare’s benefits.
Part of this has meant physically going to where millennials congregate, both on social media and elsewhere. “Sometimes you need to do a bar crawl and stay up all night talking to people about the importance of health insurance,” Stern says.
But it has also meant “specific, individualized information” that resonates with millennials’ financial and life circumstances. For example, Stern says, the campaign sponsored an ad showing the financial impact of a sprain in Chipotle burrito equivalents to demonstrate the value of investing in insurance:
The campaign also relied heavily on fraternities, sororities, community colleges and other educators. “We found trusted messengers to be really important,” Stern says.
A final critical piece was the availability of user-friendly online tools to help potential enrollees choose a plan and understand what they were buying.
For example, the organization developed a coverage “connector” to help people find coverage options in their area quickly. Later this year, Enroll America plans to roll out a coverage “explorer” so people can compare plans more efficiently.
“These are tools that are consumer-friendly to a young adult, allow them to quickly evaluate what their options are, enroll in coverage and go on with their lives,” says Stern.
Through a combination of policy and data-driven public engagement, legislators and advocates have successfully managed to reach a group that many might have thought unreachable. Moreover, the lessons learned from this strategy are potentially replicable in other contexts that demand behavioral change – such as promoting savings or chronic disease prevention.
While the gains in health care coverage are certainly good news for Obamacare’s long-term viability, as well as for the young Americans now insured, the bigger success story might be the one behind the numbers.