Life, Liberty and Healthcare? Obamacare & Young People.

The following are some highlights from a policy analysis I wrote in a Public Healthcare Policy class in the MPA program at Marist. I think this especially important to examine in light of the upcoming Presidential Election. 

Young Adults and Obamacare 

According to a study released by the Common Wealth Foundation:

"Nearly two of five young adults ages 19–29 were without health insurance for all or part of 2011, with young adults in low- and moderate-income households the most at risk. The lack of insurance had significant health and financial implications for young adults: 60 percent said they did not get needed health care because of cost and half reported problems paying medical bills or said they were paying off medical debt over time." (Collins, Robertson, Garber & Doty, 2012)

Young adults are uninsured comparatively at much higher rates than any other age population(Schwatz & Schwatz, 2008). By not having health insurance, young people start out both financially and physically vulnerable. 

For instance, look at high blood pressure monitoring. It is known that high blood pressure can cause devastating impacts on the cardiovascular and renal systems, by forcing the body to work harder. What new studies are showing, as reported by the National Institute of Health, is that “19 percent of young adults have high blood pressure [and] NIH-funded analysis indicates higher risk for young adults than previously believed” ("More young adults," 2011). By providing coverage for young people, these health related issues can be dealt with early and prevent long-term damage.        

The Affordable Health Care Act of 2010 among other things aims to address the disparity of young people’s access to insurance. This bill enables young people to stay on their parent’s insurance until the age of 26, provides increased access to preventive services, in 2014 provides access to an Affordable Health Care Exchange and tax credits for those who make under $43,000 annually ("Young adults and," 2012).  

Young Adult Healthcare Crisis

I would say it's safe to assume that we all believe access to health insurance is important because of the health and financial risks involved. 

First, access to preventive services is reduced. The CDC reports that preventive services such as blood pressure screenings can save thousands of lives ("Nearly half of," 2012).  While some young people might not feel compelled to “need” health insurance, catching these chronic illnesses early can reduce total lifetime medical costs. Young people are not getting the preventive care they need. 

The economic costs of being uninsured or underinsured is equally as great. In a study conducted by The American Journal of Medicine, researchers found that 62.1% of bankruptcies filed in 2007 were medically related (Himmelstein, Thorne, Warren & Woolhandler, 2009). For those starting out, having large medical debt can defer homeownership, economic stability and reduce productivity.

This is also an major problem for society as a collective. If young people are forgoing preventive services, there will be greater health problems down the line. Without providing insurance to young people, society is basically kicking the can down the road. 

American Values: Life, Liberty and Healthcare?

So why was there such a backlash to a bill that can help so many? This question can by answered by looking how we view liberty, freedom and equity in our society. Many feel that liberty and freedom present themselves as an inverse relationship.

To simplify this equation, anti-reformers view laws, such the Affordable Healthcare Act, as reducing freedom because insurance companies must now provide insurance to a greater number of people. They feel that this in turn limits insurance company profits (limiting economic freedom) and by extension, increases premiums on currently insured people (data proves this wrong). Whereas, pro-reformers view the law as increasing liberty by providing more access to insurance those reducing the burden of a marginalized group.

This discussion is particularly interesting when we look to define what is an American value system approach to health insurance.  Dr. Allan Brett (2009), who writes in the New England Journal of Medicine, provides an interesting analysis of this issue. He writes:

Two related assumptions are buried in the language of “American values.” The first is that there are archetypical Americans — that if we know someone fits the category “American,” it should be possible to predict his or her general worldview accurately. However, we have good reason to doubt that assumption. In nearly all respects — ethnically, culturally, religiously, politically, and socioeconomically — Americans are increasingly diverse. The recent presidential campaign provides evidence that a monolithic conception of what it means to be “American” is problematic and outdated: those who championed the idea of “real” Americans (as distinct from Americans who are somehow less representative of American ideals) were precisely those whose candidate lost the election. The second assumption is that Americans' personal values predictably translate into certain organizational structures for the financing and provision of health care…  (Brett, 2009, pgs. 440-441). 

What Dr. Brett is pointing out is of paramount concern when we start to address the issue of increasing access to health insurance. Many anti-reformers find increasing health insurance antithetical to our American values but these same anti-reformers struggle to articulate what these values are. When we start to dig deep, we see that there is no collective “American” approach towards healthcare reform.

According to a Gallup poll released on June 29, 2012, 46% of the American population agree with the Supreme Court ruling to uphold the Affordable Health Care Act with the same percentage, 46%, disagreeing with the Supreme Court ruling. (Saad, 2012). This data is consistent with previous Gallup poll findings of those who support and oppose healthcare reform (Saad,2012).  These polls reinforce the perspective that Dr. Brett is articulating in his article. In other words, there is no uniform American approach towards healthcare reform because there is no uniform set of American values to inform the approach.  What we must ask ourselves is whose America Values we are using to inform our policy.

These value conflicts come down to the way in which we frame liberty and freedom.  Deborah Stone (1988), in her work Policy Paradox, presents a view of liberty and freedom that destabilizes the inverse relationship in which many view liberty and freedom. “Power, wealth and knowledge are thus prerequisites to liberty in the positive view… If liberty is understood as the ability to make choices about matters of serious concern, then inequalities of power, wealth and knowledge also create inequalities of liberty” (p. 129). This positive view of liberty provides a way to challenge the common, oversimplified understanding of liberty and freedom. More importantly, we see articulated a way that can find a common ground among seemingly divergent believers.

The question of equality and equity are of concern in this analysis. While many agree that a lack of health insurance among young adults is a problem, some feel that health insurance is a privilege and providing insurance for those who are unemployed or recently out of school decreases equality. Others see increasing access to health insurance as a way to increase equity thus reducing the disparity of the uninsured.

I see increasing access to health insurance as both positively affecting liberty and equity. I beleive access to affordable healthcare is an American value. 

Is Obamacare Working?: 

So does the Affordable Care Act Work for young people? The simple answer is yes: 

Data released shows that there is in fact a large increase in the number of young people who are now insured. 

New results from the National Health Interview Survey (NHIS) indicate that 3.1 million additional young adults have insurance coverage as of December 2011, due to the provision in the Affordable Care Act that allows 19 through 25 year olds to remain on their parents’ insurance plans. ("State-level estimates of," 2012)

Of these young people a significant amount are youth of color. 

The data, based on combined estimates from the National Health Interview Survey and the Current Population Survey, indicate that approximately 736,000 Latinos, 410,000 Blacks, 97,000 Asian Americans, and 29,000 American Indian/Alaska Natives have gained coverage because of the law. ("Health care reform," 2012)

Additionally, 

Beginning in 2014, uninsured young adults who do not have the ability to join a parent’s health plan will have new affordable insurance options, including substantially expanded eligibility for Medicaid and subsidized private health plans for those with incomes up to 400 percent of the federal poverty level poverty ($43,560 for a single person or $89,400 for a family of four). Combined, these provisions will provide near-universal coverage for this age group. (Collins, Robertson, Garber & Doty, 2012, pg.2).

This policy, which is the most expansive healthcare reform of my generation, is an indication that business as usual is not working. This speaks to the need of a critical examination of our broken healthcare system. The trajectory of skyrocketing costs and diminishing services does not serve the best interests of our country. 

References: 

Brett, A. (2009). “American values” — a smoke screen in the debate on health care reform. The New England Journal of Medicine, (361), 440-441. Retrieved from http://www.nejm.org/doi/full/10.1056/NEJMp0905144

 Collins, S., & Nicholson, J. (2010, May). Retrieved from http://www.commonwealthfund.org/~/media/Files/Publications/Issue Brief/2010/May/1404_Collins_rite_of_passage_2010_v3.pdf

Collins, S. R., Robertson, R., Garber, T., & Doty, M. M. (2012, June). Young, uninsured, and in debt: Why young adults lack health insurance and how the affordable care act is helping. Retrieved from: http://www.commonwealthfund.org/Publications/Issue-Briefs/2012/Jun/Young-Adults-2012.aspx

HealthCare.gov, (2012). State-level estimates of gains in insurance coverage among young adults . Retrieved from website: http://www.healthcare.gov/news/factsheets/2012/06/young-adults06192012a.html

Health care reform law helps 1.3 million minority young adults obtain health insurance . (2012, March 07). Retrieved from http://www.hhs.gov/news/press/2012pres/03/20120307a.html

Himmelstein, D., Thorne, D., Warren, E., & Woolhandler, S. (2009). Medical bankrupcy in the United States, 2007: results of a national study. The American Journal of Medicine, Retrieved from http://www.washingtonpost.com/wpsrv/politics/documents/american_journal_of_medicine_09.pdf

Schwatz, K., & Schwatz, T. Kaiser Commission on Medicaid and the Uninsured, (2008). Uninsured young adults: A profile of coverage options. Retrieved from website: http://www.kff.org/uninsured/upload/7785.pdf 

State-level estimates of gains in insurance coverage among young adults. (2012, June 19). Retrieved from http://www.healthcare.gov/news/factsheets/2012/06/young-adults06192012a.html

Stone, D. A. (1988). Policy paradox, the art of political decision making. (Revised Edition ed.). New York City, New York: W W Norton & Co Inc.

The cost of lack of health insurance. (2004). Retrieved from http://www.acponline.org/advocacy/where_we_stand/access/cost.pd

Young adults and the affordable care act. (2012). Retrieved from http://www.healthcare.gov/news/factsheets/2011/08/young-adults.html

(2011). More young adults at risk for high blood pressure. NIH Medline Plus, 6(3), 10-11. Retrieved from http://www.nlm.nih.gov/medlineplus/magazine/issues/fall11/articles/fall11pg10-11.html