Photo by LaDawna Howard
When Inga Haugen set out to farm two hundred and thirty acres of rolling grass in Canton, Minnesota, she didn’t expect it to be easy. There was the fact that she was a 26-year-old woman in an industry run by graying men. There were the fifty pigs, several cows and nearly 200 chickens to buy and take care of. There was an agreement to be ironed out with her parents, who owned the land, and a tight market for the meat she hoped to sell.
But the obstacle that infuriated her was one she didn’t see coming: the extraordinary cost of obtaining health insurance for herself.
“I don’t gamble,” Haugen says, “except that I farm. You are gambling when you work with critters, with machinery.” As a small-business owner in one of the most dangerous industries in the country, Haugen needed insurance, and her options were dismal. She could reckon with a steer, but insurers deemed Haugen high-risk and overweight, which counted as a pre-existing condition, and sent her premium soaring. “It made me so angry,” she recalls. “Of all the barriers I faced trying to move home to farm, that was the one that rankled the most.” Every year, Haugen paid a fifth of her income to her insurer. She made a go of it for a few years, but stepped back in 2011 to let her two brothers try their luck on the land.
Thor Haugen, who is 23, has an advantage that his older sister did not: he can stay on the family insurance plan while he finds his footing on the farm. Some 2.5 million young Americans have recently gained coverage this way, thanks to the Affordable Care Act. The requirement that private insurers cover dependents until they turn 26 was one of the first of the law’s provisions to take effect, and the first to impact young adults in particular. By the time the full provisions of the ACA roll out in 2014, another 12 million young adults will gain coverage through an expansion of eligibility standards for Medicaid and through the creation of insurance exchanges. The law also expands access to care for young adults with insurance. Young women will no longer pay higher premiums simply because they are women, and providers will be required to cover preventive, primary and maternal care, including birth control, with no cost-sharing. Lifetime benefit caps on student health plans will be banned, along with discrimination based on pre-existing conditions.
In other words, the ACA could profoundly improve the lives of the 15 million uninsured Americans between the ages of 19 and 29. But only if it survives. The Supreme Court will rule on the constitutionality of the law before the end of this month. The young people who stand to gain from the ACA represent a political constituency that was crucial in 2008—as well as the segment of the population most likely to be uninsured. Will Obamacare get them to the polls?
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In April, Supreme Court Justice Samuel Alito suggested that the stakes are low for the millions of uninsured young Americans. “When [young adults] think they have a substantial risk of incurring high medical bills,” he said from the bench, “they’ll buy insurance, like the rest of us.” The trouble, as Inga Haugen discovered, is that many can’t afford it even if they want it. And while that population may be generally healthy, so-called young invincibles are the least likely to be insured or to be able to pay out of pocket for care when they do need it. Abigail English, director of the Center for Adolescent Health and the Law, called the idea that young adults don’t need or want insurance “completely nuts.” Young Americans “face many kinds of transitional issues,” she says, meaning they fall into gaps in coverage as they navigate from family and school insurance plans to employer-sponsored plans—additionally difficult in a grim job market in which employers are offering fewer benefits. Meanwhile, the ranks of young adults with chronic conditions like diabetes and asthma are growing, and the population is uniquely at risk for traumatic accidents.