By Abhinav Gupta Doctors for America

 What are problems with the access to healthcare for young adults (ages )?  What is the Affordable Care Act (ACA)?  What does it do for young adults?  When do measures in the ACA take effect?  Why it is important for you to have insurance?

Of uninsured, 2/3 receive “no usual source of care” Of uninsured, 2/3 skipped needed care Of uninsured, 1/2 have problems “paying medical bills” Of uninsured, 1/4 carry medical debt

 Cost ◦ Expensive, low salaries  Ineligible for employer-sponsored health insurance ◦ Part-time, unemployment  No insurance after high school/college graduation  “Young Invincibles” ◦ Unnecessary care?

 1 in 6 suffer from chronic diseases ◦ High blood pressure, cancer, asthma  1 in 10 suffer from a mental health condition  1 in 4 obese  Highest rate of injury-related ER visits  Examples of Hospitalization Costs: ◦ Asthma: $12,496 ◦ Fractured Rib: $12,000 ◦ Torn ACL: $9,220 ◦ Diabetes: $24,843 ◦ Delivery: $9,542

 Goal: Ensure accessible, affordable, quality care for all Americans ◦ Coverage to an additional 32 million Americans by 2019  Strict rules on insurance companies to provide cheaper coverage  Reform hospitals and doctors to provide better quality care  Funded by various taxes, termination of subsidies

 Insured as a dependent until age 26  Insurance Regulation  Medicaid Expansion  Online Insurance Market Exchanges and Insurance Reform  Subsidies for use in Insurance Markets  Reforms to college insurance plans

 Coverage for dependents ended after H.S./College  Since 2010, child dependents are allowed to remain on their parents’ policies until age 26 ◦ Over 600,000 have already gained insurance ◦ Affect over 1.7 million by 2013  Individual states have expanded insurance dependency laws independently ◦ Ex. NJ: 31, FL: 30, NY: 30 ◦ Some have specific requirements  Ex. Unmarried, student, same-state residency  Only for fully-insured plans  Federal law of age 26 provides uniform minimum regardless of state requirements

 Ban on discrimination based on pre-existing conditions  Ban on rescissions  Ban on annual and lifetime limits  No discrimination based on sex ◦ Cover maternal and reproductive health  Small insurance companies required to spend 80% of premiums on direct medical costs (Large companies: 85%)

 What’s Medicaid? ◦ Government-sponsored health insurance program  Covers over 60 million Americans  Based on poverty levels in states  Expansion ◦ Increases eligibility to 133% of federal poverty level  $14,400 for individual; $29,270 for family of four ◦ Will be enacted in 2014 ◦ Effect up to 8 million uninsured young adults

 ACA creates online insurance markets ◦ Ex. Orbitz, Expedia ◦ Compete on price, quality, benefits  Offer bronze, silver, gold, platinum plans  Uninsured individuals will be able to use markets  Businesses with less than 100 employees will be able to use markets ◦ Businesses with less than 25 employees receive tax credits

 Subsidies for health insurance if no employer insurance and between 133% to 400% FPL ◦ $14,400 -$43,000 per year for individuals ◦ $29,326 - $88,200 per year for family of four  Employee will receive federal tax credits based on a sliding scale ◦ Will pay between % of income on premiums ◦ Difference between this and “silver” plan cost will be paid by government  75% young adults below 400% FPL  Insure 5 million young adults

 1.6 million young adults (11% of students) enrolled in college health plans  Many had low benefits  Discriminated on pre- existing conditions, age, sex  ACA’s effect: ◦ Ban on lifetime limits, rescissions ◦ Offer coverage to all regardless of health status ◦ Provide free preventive care  Only for fully-insured plans

 The ACA requires all individuals to be insured  Negate adverse selection  Low-income Americans will be subsidized by tax credits or paid for by Medicaid  High-income Americans will be rewarded by lower insurance premiums and better access to care  Penalty: ◦ $95 or 1% of annual income ◦ 2016: $695 or 2.5% of annual income

 Sep : ◦ Dependents until age 26  Added 600,000 already; projected 1.7 million by 2013  Jan. 1, 2012: ◦ College health plans reform  Jan. 1, 2014: ◦ Expansion of Medicaid  Cover an additional 8 million young adults ◦ Insurance exchanges and tax credits implemented  Cover an additional 5 million young adults

David is a 23-year-old, who just graduated from college in May. He landed a job that does not provide insurance. He recently fractured a rib. 2009: No insurance. Had to pay $9,000 for the emergency room cost. 2014: Eligible to stay on his parent’s insurance. Left hospital with only $1,000 bill for deductible. Savings: $8,000 Mary is a 27-year-old single secretary, making $26,000/ year. She does not receive insurance from her employer. She wants to buy insurance because she has asthma. 2009: Estimated health insurance premium: $3, : With same premium ($3,391), only responsible to pay $1,874 (7.5% income) and receive $1,516 subsidy. Savings: $1,516 (45% of premium)

 Catastrophic plans ◦ Offer minimal benefits and deductible of $6,000  Unaffordable, inadequate preventive and primary care  Some College plans still not reformed ◦ Self-insured plans  Rising Healthcare Costs ◦ Stay aware of unnecessary testing, increased costs ◦ Utilize primary care to stay healthy instead of visiting emergency rooms

GET INSURED, STAY INFORMED, AND STAY HEALTHY! Check out for more information.

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 “Young Adults.” 18 July  “Reform Explained.” 15 July  “What Healthcare Reform Means for Young Adults.” reform-means-for-young-adults, 15 July reform-means-for-young-adults  “Young Adults.” 14 July  “Focus on Health Reform, May 2010.” 15 July  “Realizing Health Reform’s Potential, May 2011.” 11/May/1508_Collins_how_ACA_is_helping_young_adults_reform_brief_v5_CORRE CTED.pdf, 15 July /May/1508_Collins_how_ACA_is_helping_young_adults_reform_brief_v5_CORRE CTED.pdf  “Healthcare Reform, The Details.” Presentation by Dr. Howard Forman, Yale University School of Medicine.