Millennials have a lot to do this fall. We have to study for exams, move out of our parents’ basements, and find jobs. We also have to decide whether to repeal the Affordable Care Act (ACA). Whether or not to overturn the ACA is a big decision, and we must make an informed choice. Unfortunately, most millennials are clueless about the law. How should we get caught up before November?
By accepting the ACA’s requirement to buy health insurance as constitutional, Justice John Roberts pleased fans of the law. His decision means implementation can begin. However, the decision also gives hope to the law’s critics. His ruling that the insurance mandate is a tax means the law can be altered or overturned using the budget reconciliation process. Rather than a two-thirds majority, reconciliation requires only a simple Congressional majority, a feat dissenting Republicans may achieve in the next election.
To grab this majority, Republicans will need help from millennials. This help went to Democrats in 2008 when enthusiasm amongst voters in our generation propelled President Barack Obama to the White House and gave Democrats a Congressional majority. This year might be different, though, as enthusiasm for the President has waned. Some speculate that lack of enthusiasm will cause millennial voters to avoid the polls or vote Republican. Without millennial support, Democrats could lose Congress, the White House, and the ACA. Thus, we get to choose our own ACA adventure: if we vote Democrats into Congress and re-elect Obama, the ACA remains; otherwise, the ACA will likely be “repealed and replaced.”
This is a big decision. The cost of the ACA is estimated to approach $1 trillion and the law will determine health insurance options for nearly 50 million currently uninsured Americans. To make the right choice, voters must understand the stakes. Unfortunately, millennials are clueless about the ACA. According to Pew Research, less than half (37%) of us responded correctly when asked whether the Supreme Court upheld the law’s health insurance requirement. Almost a quarter of us (20%) guessed wrong.
Millennial ACA ignorance is surprising considering the law has already impacted many of our peers through health insurance expansions. Along with the health insurance mandate, the law allows adults age 26 and younger to remain covered by their parents’ health insurance. Although ACA reduced the number of uninsured millennials, our generation’s awareness about the law runs low. This is probably because - aside from the allowance of parental insurance for 26-and-unders - the individual mandate and many of the law’s other major provisions are timed for 2014. For those of us focused on paying rent due this month, legislative changes in 2014 seem a long way off.
How then should we cast an informed vote in 2012? Are there ways to get some crash-course insight into changes brought by the law before the fall elections? Yep. Here are five:
1) Practice primary care
The federal government has set aside money to encourage physicians, nurses, and other health care professionals to enter primary care. This money is parceled out in various ways, including available grant payments of up to $120,000 for doctors that join the National Health Service Corps and stipends of $22,000 to for nursing and physician assistant students.
2) Go to Burger King
The ACA requires fast food chains and vending machines to display nutrition information about the food they sell. They should have these facts posted by now. Bowling alleys and movie theatres ducked this requirement.
3) Move to Utah or Massachusetts
If you’re older than 26 and don’t have employer-sponsored health insurance, you might have a tough time finding cheap coverage before the state-run insurance exchanges mandated by the ACA start in 2014. That is, unless you move to Utah or Massachusetts. Both states have implemented relatively effective marketplaces to help individuals to shop for health insurance.
4) Look for work in hospital management or tax law
Hospital stocks spiked after the ACA ruling since investors predicted increased insurance coverage, which means higher revenues for care providers. Revenues might increase, but the ACA changes will not necessarily cause care to be delivered more efficiently. This will require leaders capable of directing provider organizations to increase care quality and decrease cost - a tricky balance. Millenials capable of this type of leadership will find good employment opportunities throughout the health care system. And if running a hospital isn’t appealing, you might try learning the tax code. As the IRS gears up to enforce penalties for failing to buy health insurance they plan to hire over 1,000 full-time positions this year.
5) Learn from experts
Non-partisan research institutions like the Kaiser Family Foundation (KFF), The Brookings Institute, and RAND (full disclosure: I’m a RAND employee) are great places to find analyses of the ACA, reviews of the arguments for and against the law, and commentary on the Supreme Court decision. Another useful reference is the free class on the ACA taught by a former White House health care advisor at Coursera.org.
Acknowledgements: The KFF’s ACA timeline is a great resource for learning when various provisions go into effect.