We're medical students. Recent college graduates. Like many of our peers across the country, tuition and loans loom large over our heads. When it comes to health care, though, being "young adults" is our saving grace. That's because, like millions of Americans our age, we can stay on our parents' insurance until we turn 26.
As medical students on a path toward employment, we're 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 provision of the Affordable Care Act (ACA) that lets young adults stay covered by their parents, our friends—some of whom have conditions like diabetes, arrhythmia and cancer—could have left school in debt, at risk and uninsured.
While many have rightly pointed out the broad stakes of the ACA—the Medicaid expansion, pre-existing condition protections and Medicare financing—less attention has been paid to what the ACA has meant for young adults. Prior to the ACA, we had the highest uninsured rate of any age group and lowest rate of employer-sponsored insurance. Young adults are less financially secure than older adults, and before the ACA, nearly half of uninsured young adults reported medical debt or difficulty paying medical bills.
Through the ACA, an estimated 2.3 million young adults aged 19 to 25 gained health care coverage between 2010 and 2013. According to surveys conducted by the Commonwealth Fund and the federal government, this increase in coverage was the largest among any age group.
Young adults have similarly benefited more than any other age group from the ACA's Medicaid expansion. Previously, most states limited Medicaid eligibility to those who were very low income, elderly, disabled, children, pregnant or had kids. Expanding eligibility to all adults with incomes less than or equal to 138 percent of the poverty level has allowed many more young adults, particularly young men, to receive coverage.
Even though young adults may seem to be a fit, low-risk group, the Medicaid expansion under the ACA has had huge health benefits. Low-income young adults received access to affordable health plans with increased services like mental health care, preventive care, prescription drugs and maternity care. Last year's highly publicized case of BYU-Idaho initially deeming Medicaid to not be school-acceptable insurance highlights the expansion's importance. Low-income BYU students already struggling to pay for rent—some of whom were married with children—could not afford the school's health insurance, let alone private coverage. Imagine if those students also didn't have expanded Medicaid as an option.
Young adults, while generally healthier, are also not immune to pre-existing condition discrimination. One in six young adults struggles with a chronic illness that might make it harder to purchase health care. Young adults aged 18 to 25, for instance, have the highest prevalence of mental illness or serious psychological disorders, and the isolation of the pandemic is only making matters worse. Access to affordable health coverage is essential for this population. Yet without the ACA, they could be excluded from coverage.
And during a pandemic where COVID-19 could be considered a pre-existing condition and young adults are experiencing job losses at rates far higher than other groups, these provisions are even more crucial. Though the impact of COVID-19 hasn't been as dire in younger populations as with older individuals, young people now make up the largest share of new infections and are far from invincible. The losses of a 19-year old Appalachian State student and 28-year old Houston OB-GYN resident due to COVID-19 complications illustrate this. Not to mention the apparent longer-term consequences COVID-19 can have on the brain, which could jeopardize any young person's future.
Our experience seeing patients during medical school has also brought home to us how important these ACA protections are for our generation. Last year, one early 20s patient came into the hospital with severe diabetic ketoacidosis, a life-threatening complication of diabetes that requires extremely costly treatments. Fortunately, that patient received the care they needed—because they had the insurance to cover it.
But in a world without the ACA—one that could soon exist after a November 10 Supreme Court challenge to the law supported by the Trump administration and Republican-led states—patients could be denied health coverage due to pre-existing conditions. They would not have the option of staying on their parent's coverage past high school or accessing expanded Medicaid.
That's why so much is at stake for our generation with the ACA. We've seen it with our classmates with pre-existing health conditions. We've seen it with young adult patients in unexpected ER visits. We've seen it in our own lives, as we've wondered what would happen if we got COVID-19 with severe complications. President Donald Trump's continued attacks on the ACA could put our generation's health in jeopardy.
Young adults: Our health care is on the line, too, 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 the authors' own.
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