The following is a proposal for PolicyMic's "Open Mic" on "Making Health Care Work For Our Generation." Abridged sections of this proposal were submitted to the "Local Education," "National Engagement," and "Policy Proposals" categories. For more details, please visit
http://policymic.com/healthcare.
Increasing
Millennial Enrollment in Health Insurance: A Multi-faceted Approach
Background1:
Signed into law
in March 2010, the Affordable Care Act significantly changes the US healthcare
system by affecting how people receive and pay for healthcare. The biggest and
most important change is the requirement that all Americans who can afford
health insurance must purchase a policy or pay a tax penalty. Those who do not
enroll will face a fine of $95 or 1% of income (whichever is higher) in 2014.
This fine increases to $325 or 2% of income in 2015 and $695 or 2.5% of income
in 2016.
In addition, the
Affordable Care Act also: (1) allows young people to remain on their parent’s
health insurance until age 26; (2) requires health insurance companies to
provide more comprehensive coverage; (3) requires businesses to provide minimum
health coverage to employees; and (4) increases coverage of certain procedures
in maternal and reproductive health. The goal of these reforms is to maintain
and improve quality of care, while reducing unnecessary and inefficient costly
expenditures.
Problem1:
The success of
the Affordable Care Act depends on enrollment of Americans, especially among
Millennials (aged 18-35) in health insurance. To offset the higher health
expenditures of older Americans, the Affordable Care Act relies on lower health
expenditures from younger Americans. In particular, at least 2.7 million young
Americans need to sign up for health insurance. Of the 78 million Millennials
in the US,
more than 27% currently do not have health insurance and 42% do not know about
state health exchanges. This proposal will specifically target Millennials
without health insurance.
Solutions:
As with any major
government reform, support from various stakeholders is required to ensure
successful implementation. Government agencies must encourage and facilitate
the process by educating the public, incentivizing health insurance adopters,
and working with activists and public figures to raise awareness. Initiatives, such as Obama’s “Health Care for the Holidays,” are just the
start to this process.
1. Education: Teaching Through Academic
Institutions, Town Halls, and Other Public Facilities
To increase enrollment among Millennials, these
youth need to be educated about what the benefits of health insurance are, why
they should enroll in health exchanges, and how to enroll. For younger Millennials
still in school, academic institutions can play a major role in this effort.
Student groups and the school administration can hold constructive discussions
and dedicate days (i.e at the beginning of the semester) that focus on health
reform and its implications. Schools can even directly help students enroll by
walking them through the process and answering any questions.
This approach
requires commitment and participation from both schools and students. Although
many academic institutions require students to have health insurance, not all
have that requirement. These schools can be incentivized to help students
enroll because this would decrease financial burdens, especially for those
receiving financial aid. Furthermore, if students do become sick during the
academic year, this will minimize unexpected out-of-pocket health costs,
especially for the uninsured.
To increase health insurance
enrollment among the poor, similar education initiatives could be held at
public libraries, town halls, local YMCAs, and other community centers on
pre-specified dates. By staffing people at these locations, in addition to call
centers, people can directly have their questions answered. This would allow
people without access to computers to learn more and determine what the
benefits and costs of health insurance are for them.
Potential
Challenges:
Implementation of such an education
program requires considerable time, resources, and capital.
Commitment and participation from academic
institutions, public libraries, town halls and other community centers will be
critical to success. Given that many states and citizens do not fully support
the new health reforms, they will not support these education initiatives
either. However, the main goals of this approach are to inform people about changes
to health care and generate discussions. It will be necessary to engage these
stakeholders and evaluate what is necessary for their support. It will also be
necessary to create simple, yet informative brochures and pamphlets that
explain the core concepts of the Affordable Care Act and dispel any myths. Money
is needed to prepare and distribute materials, finance local enrollment
centers, and train enrollment staff.
2. Financial Incentives: Tax Benefits for New
Health Insurance Enrollees
Instead of
relying just on penalties to convince people to enroll in health insurance, the
US
government should also consider creating incentives, such as tax benefits. Since
open enrollment ends March 31, 2014 and the deadline for IRS tax filings is
April 15, 2014, the government could provide tax benefits for new enrollees to
health insurance. For instance, to reach the goal of 2.7 million new enrollees,
a tax deducation of a fixed amount, such as $50-100, for every newly insured
person would only cost $135-$270 million.
Such a small
amount could be offset by penalties from those who do not enroll in health
insurance. Furthermore, despite the initial loss to the US government,
there would be significant long-term benefits because these enrollees would be
offsetting high costs from older Americans and ensure the success of the
Affordable Care Act. If necessary, the US government could even consider
raising penalty fines to finance a portion or all of the tax benefits for early
adopters of health insurance.
Potential Challenges:
Approval of financial incentives
for new health insurance enrollees ultimately depends on the US Congress. Given
the significant debates regarding the national budget and the deficit, it may
be difficult to decide how to finance such tax benefits. Furthermore, there
could also be opposition from people who have already been enrolled in health
insurance. If these financial incentives are approved, then the IRS will have
the additional burden of verifying that tax filers are indeed new health
insurance enrollees.
3. Digital Advertising Campaign: Engaging
Corporations and Public Figures
Imagine if
enrolling in health insurance was as popular as the latest pop song or artist.
People’s health care should be just as important as the latest fads.
Since most
Millennials are tech-savvy and aware of popular trends, a digital advertising
campaign with celebrities and popular companies would be effective. By
partnering with corporate sponsors, such as Nike, Adidas, Coca Cola, etc., and
featuring short Youtube videos from athletes, artists, performers, etc. the
government can make enrolling in health insurance popular. Another approach is
to host online discussions (i.e via Reddit) and encourage popular figures to
lend their support for enrolling in health insurance.
With
limited time to read about health care changes, Millennials need to be
encouraged to learn. Short videos or advertisements with popular figures
that explain the core components and dispel the biggest myths would motivate
them to actually learn more. Such videos and advertisements can become viral
and reach a large part of the population. If Millennials realize the importance
of health insurance and the fact that everyone, including celebrities and world
leaders, needs it then they will be more inclined to enroll themselves.
Potential Challenges:
Success of a digital advertising
campaign largely depends on developing marketing material and receiving buy-in
from large corporations and public figures. It will also be necessary for
either the government or sponsors to finance creation and implementation of an
advertisement campaign. A simple, yet creative message about the importance of
health care and health insurance will be critical to success.
Conclusion:
A multi-faceted approach that involves education, financial
incentives and digital advertising is needed to increase health insurance
enrollment among Millennials and ensure the success of the Affordable Care Act.
No one approach alone is enough; a collective and broad effort is imperative.
