We are medical students. The youngest university graduates. Like many of our peers across the country, tuition fees and loans are above our heads. But when it comes to health care, our saving grace is to be “young adults. That’s because, like millions of Americans of our age, we have been able to keep our parents’ insurance up to our 26th birthday.
As medical students on their way to work, we are the lucky ones. Many of our friends who recently graduated college found themselves on an unsuccessful job search in the middle of a pandemic. Without the provisions of the Affordable Care Act (ACA), which allows young adults to remain insured by their parents, our friends – some of whom suffer from conditions such as diabetes, heart rhythm disorders and cancer – could have left school in debt, at risk and uninsured.
While many have rightly pointed out the major challenges of the ACA – the expansion of Medicaid, existing disease coverage and Medicare funding – little attention has been paid to the impact of the ACA on young adults. Prior to the ACA, we had the highest rate of uninsured people of all ages and the lowest rate of employer-sponsored insurance. Young adults are less financially secure than older adults, and prior to the ACA, almost half of the uninsured young adults reported medical debts or difficulties in paying medical bills.
Through the ACA, an estimated 2.3 million young adults between the ages of 19 and 25 received medical care between 2010 and 2013. According to surveys by the Commonwealth Fund and the federal government, this increase in coverage was the largest of any age group.
Young adults have similarly benefited more than any other age group from the Medicaid expansion of the ACA. Previously, most states limited Medicaid eligibility to people on very low incomes, the elderly, the disabled, children, pregnant women, and those with children. By extending eligibility to all adults with an income not exceeding 138 percent of the poverty line, many more young adults, especially young men, were able to benefit from Medicaid.
Although young adults appear to be a suitable low-risk group, the extension of Medicaid under the ACA has brought enormous health benefits. Young low-income adults have been given access to affordable health plans with expanded services such as mental health care, preventive care, prescription drugs and maternity care. The heavily publicized case of BYU-Idaho last year, which initially did not consider Medicaid to be an acceptable insurance for schools, underscores the importance of expansion. Low-income BYU students who already had difficulty paying the rent – some of them were married and had children – could not afford the school’s health insurance, let alone private insurance. Imagine if these students had not extended Medicaid as an option either.
Young adults, while generally healthier, are not immune to discrimination based on previous illnesses. One in six young adults is struggling with a chronic disease that could make it difficult to receive health care. Young adults aged 18-25, for example, have the highest prevalence of mental illness or severe mental disorders, and the isolation of the pandemic only makes matters worse. Access to affordable health care is crucial for this population group. But without the Court, they could be excluded from coverage.
And during a pandemic, in which COVID-19 could be considered a pre-existing condition and young adults lose their jobs far more often than other groups, these precautions are even more crucial. Although the effects of COVID-19 were not as severe in younger populations as in older people, young people now account for the majority of new infections and are far from invincible. The losses of a 19-year-old student from the Appalachian Mountains and a 28-year-old OB-GYN resident from Houston due to COVID-19 complications illustrate this. Not to mention the obvious longer-term consequences that COVID-19 can have on the brain, which could endanger the future of every young person.
Our experience with patients during their medical studies has also made us realize how important these ACA protective measures are for our generation. Last year, a patient in his early 20s was hospitalized with severe diabetic ketoacidosis, a life-threatening complication of diabetes that requires extremely costly treatment. Fortunately, this patient received the necessary care because he was covered by insurance.
But in a world without the Court of Auditors – a world that could exist soon after a Supreme Court challenge of the law on November 10, supported by the Trump government and republican-led states – patients could be denied health insurance because of pre-existing conditions. They would not be able to stay on their parents’ health insurance after high school or have access to extended Medicaid.
This is why so much is at stake for our generation with the ACA. We have seen it among our classmates with pre-existing health problems. We have seen it in young adult patients during unexpected visits to the emergency room. We have seen it in our own lives because we wondered what would happen if we were given COVID-19 with serious complications. President Donald Trump’s continued attacks on the Court of Auditors could put the health of our generation at risk.
Young adults: Our health care is also at stake this November.
Jesper Ke is a medical student at the University of Michigan.
Mathew Alexander is a medical student at Virginia Commonwealth University.
Suhas Gondi is an M.D. and MBA candidate at Harvard Medical School and Harvard Business School.
The views expressed in this article are those of the authors….
