Alexandrea Conway and Ethan Johnston talk about health insurance at Milltown in Carrboro.
Alexandrea Conway and Ethan Johnston talk about health insurance at Milltown in Carrboro. Photo credit: Hyun Namkoong


Paperwork and cost are factors cited by young people for not signing up for health care coverage.

By Hyun Namkoong

Today is the last day to sign up for coverage under the Affordable Care Act, and the White House and insurers have been working hard to enroll young people.

Contrary to the perception suggested by the commonly used term “young invincibles,” young people aren’t, in fact, invincible. Statistics from the CDC show that one in six young people have a chronic illness such as diabetes or asthma. And almost half of those young people report having difficulty paying for their medical bills.

Young people are concerned about their health. But complicated paperwork and the cost of health insurance are big factors for not seeking coverage.

“Just tax me, I’ll deal with it. I’m not going to be able to afford it,” said Alexandrea Conway of Chapel Hill, a 29-year-old who works full time as a babysitter.

Enrollment in the state

In North Carolina, an estimated 27 to 32 percent of young people are uninsured, which is consistent with the national average.

Enroll America NC has prioritized places frequented by young people – such as community colleges, restaurants and bars – to bolster the number of young people enrolled, said Sorien Schmidt, state director of Enroll America, a not-for-profit organization that has been working to enroll people in the marketplace insurance plans.

Alexandrea Conway said she's ready to pay the tax penalty created by the Affordable Care Act, rather than get insurance. Photo credit: Hyun Namkoong
Alexandrea Conway said she’s ready to pay the tax penalty created by the Affordable Care Act rather than get insurance. Photo credit: Hyun Namkoong

“[Insurers and the government] want to get a higher proportion of younger people, but that’s not easy to do,” said Jonathon Oberlander, a UNC-Chapel Hill professor in health policy and management and an expert in national health policy.

Enrollment data from the federal government show that young people are dragging their feet to get coverage. They had the greatest increase in enrollment in February compared to all other age groups. A surge in enrollment is expected in the days leading up to the deadline.

“Maybe I’ll get it in April or May. I’m gonna get it,” Conway said. “I’m just not in a rush.”

Can’t afford it

Many young people work in child-care services, restaurants or construction and they often live paycheck to paycheck or depend on tips.

Conway had insurance through the family who employs her, but had to drop her insurance plan because she needed to pay other bills. “I would love to have it. I just hope and pray that I won’t need it,” she said.

Young adults have the lowest rates of access to employer-based insurance. They tend to have entry-level jobs, part-time positions or other forms of employment that don’t offer health insurance. Young people aged 19 to 34 have the highest uninsured rates of any age group in the country, representing 40 percent of the uninsured population under 65.

It’s still very expensive for a lot of young Americans, specifically those who aren’t qualifying for financial assistance, Oberlander said. Subsidized coverage is available for individuals and families with incomes between the thresholds set by the government.

Fortunately, the estimated 75,000 unemployed North Carolinians under 26 can now stay on their parent’s insurance plan, one of the most popular and well-known provisions of the ACA.

“The one thing we talk about is they could be on their parent’s insurance,”  Schmidt said. “A lot of young people are aware of that as an option and they just want confirmation.”

First-time buyers

This tech-savvy generation doesn’t face the technology barrier that other age groups might.

“Young people have an advantage because they are more likely to use the computer,” Schmidt said. “A higher comfort level with being on the Internet is a huge help.”

But many young people are purchasing insurance for the first time, a process they find overwhelming.

Ethan Johnston, 26 years old, is the co-manager at 5th Season in Carrboro and also bartends at Milltown to make some extra cash. He hasn’t had health insurance since 2009; he’d like to see a doctor and get a physical.

Ethan Johnston has not been insured since 2009 and said the complicated paperwork was one factor keeping him from signing up.
Ethan Johnston has not been insured since 2009 and said the complicated paperwork was one factor keeping him from signing up. Photo credit: Hyun Namkoong

Both Conway and Johnston cite “complicated paperwork” as a key factor for not getting coverage.

“I started filling out the paperwork from my employer, but I just stopped,” Johnston said. “There was a lot of it.”

“A lot of people are concerned about the fine print. We’re telling everybody you can get help if you’re worried about the fine print,” Schmidt said.

Navigators, certified application counselors and insurance agents and brokers are available through the marketplace and other organizations to help people understand the language and the application process of purchasing insurance.

Balancing the risk pool

The ACA requires insurers to provide coverage to anyone who wants it regardless of pre-existing conditions or gender. Premiums based on age previously could be a five-to-one ratio, meaning that a premium for a 64-year-old could be five times higher than that of a 19-year-old; they can now be no more than a three-to-one ratio.

Older adults pay premiums that don’t fully cover their expected medical expenses while younger adults pay more. For the heath care reform plan to work, a sufficient number of young people need to enroll to offset the cost of older adults.

“Insurers and the government want a more stable risk pool,” Oberlander said. “If there aren’t enough young people who sign up, it makes the risk pool older and sicker.”

But that also means the young people who do enroll need to be healthy.

“Age is used as a proxy. We know that younger people, on average, are healthier, but we don’t really know the health status of the people signing up,” Oberlander said.

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Hyun graduated from the UNC-Chapel Hill Gillings Global School of Public Health in the health behavior department and she worked as the NC Health News intern from Jan-Aug 2014.