Shyama Venkateswar Distinguished Lecturer, Hunter College and Director, Public Policy Program, Roosevelt House

Posted on March 31, 2014 · Posted in Frank Friday

It has been four years since the Affordable Care Act (ACA), more popularly known as Obamacare, was signed into law, and on the heels of today’s sign-up deadline, President Obama began a new media blitz to capture the attention of uninsured millennials. At the same time, Republican-­aligned groups like Generation Opportunity have ran campaigns of their own imploring millennials to opt­ out.

I am apprehensive to lend credence to any message that plays on the irrational fears of the misinformed, as in the latter case, but no one can deny that there are real problems with the ACA that must be addressed, many of them unique to millennials.

Things are not easy for millennials. We work harder for less and less, and begin adult life neck deep in the red with record ­high student loan debt. Corporate profits are skyrocketing, yet wages remain stagnant and jobs continue to be scarce. Many of us are under-worked in one or two low-paying, part-time service jobs, while others are trapped in a seemingly permanent cycle of unpaid internships. Suddenly, being saddled with a mandatory premium on health insurance is an uncomfortable, and for some, impossible prospect. And it gets worse.

The penalty for not buying into Obamacare is about $95 or 1% of income, whichever is higher. For an income of $30,000, that is equal to $300, and when the penalty jumps up to 2% next year, that means a steep $600. Low income individuals receive subsidies to offset costs, but those top out at an annual income of $25,000, meaning there is a significant number who fall into a gap where they don’t qualify for subsidies, yet they can’t afford an unsubsidized policy from the exchanges.

While I was fortunate enough to qualify for Medicaid in the state of New York, many of my peers are struggling. One of my friends owes about $90,000 in student loans for two degrees and can’t seem to find a job that pays a living wage. He qualifies for subsidies, but those cannot be applied to the only plan he can afford, a high deductible, catastrophic coverage plan available for those under 30. Thus, he is forced to choose between a new insurance premium, rent, or defaulting on his debt payments. Another of my friends has a graduate degree from Carnegie Mellon University, and is currently unemployed. She would be eligible for Medicaid, had the Republican governor in her state not refused to accept the Medicaid expansion.

While these are considerable problems with the ACA, one thing that is important to remember is that other options simply aren’t feasible in the United States. The so-called public option that progressives once clamored for, or even a British-­style, government-­run universal healthcare system are attractive, but the chances of either ever coming to fruition in the U.S. is dishearteningly slim. The ACA itself was passed after compromise and capitulation by a very slim margin, despite the fact that the individual mandate that anchors the law was originally a Republican idea hatched by none other than the arch­-conservative Heritage Foundation. To paraphrase Ezekiel Emanuel, one of the architects of the ACA who recently came to Roosevelt House for a discussion on his new book “Reinventing American Health Care”: “You deal in politics with what you get, not what you want. In a democracy, you’re not gonna get a perfect bill.”

While there are many merits to Obamacare, it is not a solution to the healthcare crisis in America; rather, it is a bandage on an archaic, illogical, and broken healthcare system. Further steps need to be taken to address the problems millennials and the rest of the country face in accessing affordable, reliable, and quality healthcare. Increasing subsidies in proportion to a current or former student’s debt load would be one step. Forgoing shameless political posturing would be another.

Either way, one can’t shake the fact that an unexpected trip to the hospital for a broken leg or a sudden illness very likely would become a lot more expensive in the long run than the government-imposed penalty from not purchasing insurance. Some people may even qualify for a hardship exemption, if the lowest priced insurance plan is more than 8% of one’s income, for example. This is why I urge everyone who can to sign up and at least see what the options are. Who knows? You might find a bargain.

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The writing and opinions expressed herein are those of the authors and do not necessarily reflect the positions of the Roosevelt House Public Policy Institute or Hunter College.