A Poor Millennial’s Health Care Dilemma

R.K. Owen Oct 31, 2013

I haven’t seen a doctor in years. So far, there hasn’t been an urgent need — I’m young, in good health, and have been lucky enough to not get into any accidents. Yet. I also don’t have health insurance, principally because I can’t afford it. The same goes for many of my peers in their twenties, who are healthy, glaringly poor and more often than not, lacking access to health care.

On October 1, the health care exchanges that are the main feature of the Affordable Care Act went live. An estimated 8.6 million people all over the country went on the federal health website in the first three days, and savvy news commentators — those that found a breath between discussions of the Obamacare-centered government shutdown — pointed to the program’s reliance on young people’s participation for fiscal success. The Obama administration hopes that 2.8 million uninsured youth, of about 18 million total, will sign up for health coverage through the exchanges. As the logic goes, healthy young people must pay in to make the health insurance offered on the marketplace exchanges affordable by balancing out the costs for their sicker, and often older, counterparts.

And yet, many of us don’t find ourselves to be in a position to pay into anything. Those of us who are roughly 30 and under — also known as “millennials” — and more specifically, those who entered the labor force after the beginning of the Great Recession, are faced with a dilemma: try to do what you want, or try to achieve financial stability. Opportunities for accomplishing both are scarce.

My family immigrated to the United States when I was a child, and as a teenager I was studious enough to get accepted into one of the top universities in the country and poor enough to receive a massive no-strings-attached financial aid package. Upon graduating, brand-name degree in hand, I set about trying to begin the career I wanted with the goal of eventually getting paid in the process. The year was 2011, and the moment coincided with the outpouring of hundreds of thousands of beleaguered young people, many of whom were saddled with student loan debt and struggling with limited economic prospects, into the nationwide Occupy uprising.

Close to two years of living at home, several unpaid internships and countless hours spent worrying about my lack of financial security later, I scored a job. It’s enjoyable and in my chosen field. It also pays just enough for me to cover rent for a tiny Brooklyn bedroom, groceries and the occasional beer with friends. Making it cover my health care costs would be a stretch, even with the subsidies offered by Obamacare.

Young adults disproportionally lack health insurance: over a quarter of Americans ages 18-34 aren’t insured, compared with about 15 percent of the total population. With the rollout of Obamacare, we are now faced with four options:

1. Stay on our parents’ insurance, if we’re 26 or younger;

2. Apply for Medicaid, if we meet the newly expanded eligibility requirements of earning less than $15,856 a year for a single person;

3. Try to find our way through the maze of plans available on the newly formed health care marketplaces;

4. Do nothing and pay the resulting tax penalty.

Those of my peers in their mid-twenties who can are opting to stay on their parents’ insurance. I personally don’t have that option — with both parents citing that adding me to their plans would cost hundreds of dollars more every month, and provide low-quality coverage at that — so in the coming weeks, I’ll be applying for Medicaid. While the coverage it offers is limited, it does pay for costly expenses like visits to the emergency room.

It feels like a golden stroke of luck that my current job pays just little enough for me to be eligible for the government-sponsored health coverage. But the financial dilemmas remain: what will happen if I change jobs, begin to earn a little more than I do now, lose my eligibility and have to buy coverage on the exchanges? Will I be able to afford it? What about those of my peers whose window of time to stay on their parents’ plans is quickly closing? What about those for whom it never existed in the first place?

With Obamacare’s government subsidies, a single New Yorker earning $16,000 a year — just over the law’s Medicaid threshold — would pay $45 in monthly premiums for a “silver” insurance plan. Someone earning $20,000 would pay $85, and someone earning $30,000 would pay $209.

For many of us who are just trying to survive, scraping together even $45 a month can mean having to go with less — less material basics, less movement, maybe even less food. Perhaps I would take on the added expense, but if I were to actually need health care, I would face hefty co-pays and deductibles, along with the prospect of insurance company officials trying to deny me services at every turn. If something serious happened to me, I would be out many thousands of dollars I simply don’t have.

So, no thanks. Young people like myself, the so-called “invincibles,” certainly see the value in having health coverage. But it’s much harder to see the value in tossing our meager earnings to private insurance companies, which make away with billions of dollars while so often denying care to those they’re supposed to serve.

R.K. Owen is a psuedonym.

RELATED COVERAGE from Issue 191:

Health Care Market Madness, by Margaret Flowers

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