For 'Young Invincibles,' Insurance Isn't Just A Health Issue

For the Affordable Care Act to work, young, healthy people have to sign up for the new insurance exchanges. But these so-call Young Invincibles have a number of reasons for forgoing coverage. Host Scott Simon talks with Lisa Dubay of the Urban Institute about these 18- to 35-year-olds.

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SCOTT SIMON, HOST:

This is WEEKEND EDITION from NPR News. I'm Scott Simon.

There's a group of Americans who've been dubbed the Young Invincibles. They're not, of course. But they are young, healthy and people the administration needs to buy health coverage under the Affordable Care Act. The new health insurance exchanges opened October 1st and officials want at least 2.7 million of the seven million estimated new enrollees to fall inside that 18 to 35 age range to keep insurance rates low.

The president and Hollywood stars have made special appeals to this group, nicely reminding them that those who choose not to enroll have to pay a fine. In 2011, over 18 million of these young adults were not insured for health care.

We spoke with Lisa Dubay, a fellow at the Urban Institute, about why many have not had coverage.

LISA DUBAY: Only about 11 percent of the uninsured Young Invincibles aren't purchasing coverage because they think they don't need it. Most of them are saying they're not purchasing coverage because it's unaffordable. So I'm not convinced that they're not going to enroll. I think they probably will enroll. If the rates are good and they look like they're going to be low with the subsidies, I think that we will get Young Invisibles to come in. And they have a lot of options.

They can buy a catastrophic plan if they're under 30. They can buy a plan that is cheaper than, you know, the average plan. So I think the flexibility that the exchanges offer to the Young Invincibles, as well as the subsidies, will get them enrolled.

SIMON: Being in journalism, I think we can both understand why this phrase Young Invincibles has taken off, although you've convinced me we're, you know, actually that's - it's probably a phrase that more colorful than accurate. Nobody is really invincible, are they?

DUBAY: No, and I mean I think we think of them as being Young Invincibles because they don't have the same kind of health care costs that someone my age would have, or your age would have - so they're cheaper. But, you know, they're transitioning from adolescents to adulthood. So they're actually, you know, they have reproductive and contraceptive needs that this is the group that has the highest birth rate of any other cohort of adults. Ninety percent of them are having sex.

They have the highest rates of having any mental health illness in the past year and of having a severe mental health illness in the past year. So it's the time when there's a lot of risky behavior going on. So they're using more drugs, they're smoking; they're drinking more than other adults. And so, those are all places where both curative and preventive care is really important to this particular age group.

SIMON: Yeah. It sounds like you're not concerned, at least over the next six months, that this group is not going to sign up.

DUBAY: You know, we don't know what's going to happen. I'm more concerned about the four million young adults that are living in states that are not expanding Medicaid. Those people would be eligible for Medicaid if the states had expanded. They don't have other options for coverage. I have a 23-year-old daughter and she's, you know, is working at a place that doesn't offer insurance coverage. I can put her on my health insurance plan, and I have because of Obamacare. But for these kids, their parents don't have health insurance coverage. They really have no options. So there's just this huge group that we're leaving there.

SIMON: Well, is there a little - we call it inevitably elevator/escalator speech these days you give to somebody, a young person who is thinking, you know, I really can't afford this?

DUBAY: Well, I would start by saying have you looked at the rates because they're pretty low. You know, if you're making $25,000 a year, you would probably pay $145 a month and that would be for full coverage. I mean, that's still a lot of money but you could buy a catastrophic plan for less. You could buy, you know, a Bronze plan for less. There are lots of different ways you could go.

SIMON: Lisa Dubay, of the Urban Institute.

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