Young adults believe they are indestructible and don't need health insurance — or so people often say in discussions about Obamacare.
Surveys, statistics from major employers and interviews with people in their 20s and 30s, however, show that the majority of young adults enroll in workplace insurance. And if they don't have health insurance, the most likely reason is the expense.
Only about one in four young adults nationally understands what the federal health insurance overhaul might offer them, but interviews locally indicated interest in finding out.
Keaton Segura, a 21-year-old Omahan who works two jobs as a cook, has no health insurance, “mostly because I can't afford it right now.”
He intends, though, to see what kind of insurance he might purchase in a health insurance marketplace, a creation of the Affordable Care Act that will be available starting Oct. 1. “My mother's been encouraging me to do so,” he said.
The participation of young adults in the insurance marketplaces will play an important role in the cost of insurance obtained through that system. The presence of many young, healthy people in the pool will help keep premiums reasonably priced for everyone as the system expands to take in millions of uninsured people, including those with chronic illnesses.
Marketplaces basically are online systems in which people can calculate their eligibility for federal tax credits to subsidize premiums, compare insurance policies with various levels of coverage and out-of-pocket costs, and enroll. They are not intended for people who have Medicare, Medicaid or Tricare, the health plan for military families.
People with group insurance through their employers generally should get their information about 2014 costs and coverage from their workplaces.
The federal government hopes about 7 million people sign on through marketplaces, and about 40 percent of those are young people.
Community groups and activists are trying to get the message out across Nebraska and Iowa about the October-through-March enrollment period in the marketplaces, also known as exchanges. Coverage would start Jan. 1.
President Barack Obama has encouraged recent college graduates to “spread the word to your fellow young people” about the importance of health insurance. And the federal government has awarded a $41.2 million contract to the Weber Shandwick public relations firm to conduct a campaign that will include outreach to young adults through Facebook, ESPN.com, popular TV shows and other places.
National studies and anecdotal information locally suggest these efforts might find listeners, because young people consider health insurance a valuable commodity. A Kaiser Family Foundation poll earlier this year found that more than 70 percent of people ages 18 to 30 considered health insurance “very important” and “something I need.”
Though somewhat lower than the percentage of people of all ages who felt that way, the result defies the notion that younger people consider themselves invincible, the Kaiser report says.
At Mutual of Omaha, only 16 percent of employees ages 26 to 29 waive the company health insurance program compared with 23 percent of those 30 and older who waive it, Mutual spokesman Joe Clauson said.
And at the University of Nebraska Medical Center, 82.7 percent of full-time employees 32 and younger buy into their employer's plan, compared with 82.8 percent of those ages 33 through 47 who buy into the plan.
Jim Garbina, a senior vice president with the Harry A. Koch Co. insurance brokerage firm in Omaha, said that, on average, about 70 percent of people buy coverage from their employers. There is little difference in that percentage between young people and older people, said Garbina, whose firm helps 1,000 companies and organizations find insurance packages.
David Lyons, CEO of CoOportunity Health of West Des Moines, which will sell policies in Iowa's and Nebraska's marketplaces, said enrolling a high percentage of young people will be important. “I don't think there's any magic number. It's a key market segment for us.”
Christine Quick, a University of Nebraska at Omaha graduate student, has been on her father's insurance plan but needs her own plan when she turns 26 in October. She is looking for a health plan through UNO, Blue Cross Blue Shield of Nebraska or the marketplace.
When a car ran over her foot in 2012, she landed in an emergency room. Without her father's insurance, she would have been in financial trouble, she said.
“You just never know what's going to happen,” Quick said.
In a survey conducted this year by the Commonwealth Fund, only 5 percent of 19-to-29-year-olds who chose not to enroll in a workplace health insurance plan said they didn't need it. Most were enrolled in a spouse's or parent's plan, but 22 percent of the unenrolled said coverage cost too much.
Curtis Cutler, 32, said that when his wife, Tami, gave birth to their daughter, Cameron, three years ago, it would have been cheaper to pay cash for prenatal appointments and the hospital stay than to pay for his company-provided insurance. Monthly premiums had risen to $600 a month, and the deductible at his computer company was $4,000, he said.
“It just wasn't worth it for me, at my office,” Cutler said. Last year the software developer decided to go without insurance while his wife and daughter went on a plan through Tami's workplace.
“I guess I've just been gambling that I wouldn't get sick,” Cutler said.
Nevertheless, he said he's done some research and hopes he can find an affordable plan in the online marketplace.
The law includes some encouragement: In most cases, those who choose to go uninsured will be fined $95 per person in 2014, $325 in 2015 and $695 the following year.
Studies indicate that many young people remained unaware of the marketplaces. The Commonwealth Fund reported last month that only 27 percent of 19-to-29-year-olds were familiar with them.
Khari Reynolds had a vague understanding of the coming changes in U.S. health insurance. “I don't know the full extent of how it all works,” he said.
Reynolds, 35, is a part-time fire sciences instructor at Metro Community College and a part-time personal trainer. He said he can't afford health insurance.
He had his wisdom teeth pulled out a few weeks ago and received a $1,500 bill that he had to pay out of pocket. Even if dental insurance for adults won't be in many marketplace plans that will be offered this fall, Reynolds realized it's important to have insurance.
“Things are starting to fall apart a little bit more, and I'm starting to understand the cost of health care,” Reynolds said.
UNO junior Kyle Thomsen said he rarely needs medical attention, and that when he does, his university has a free clinic. Asked whether he has health insurance, the 20-year-old engineering student said: “No idea. I think my parents have the health insurance.”
Community groups, health clinics and activists in Nebraska have the tough job of informing the public about the opportunity to take advantage of the insurance marketplace.
Karen Pollitz, a senior fellow at the Kaiser Family Foundation, said states that run their own insurance marketplaces have had access to more federal money for implementation and promotion. States such as Colorado and Minnesota, which will manage their own marketplaces, have embarked on big promotional campaigns.
States such as Nebraska with federally run marketplaces have had access to far less money. Iowa, which will have a joint state-federal marketplace, awaits word on its application to the federal government for $3.5 million for promotion.
“I think it probably will be a little tougher in the states where the state officials haven't been working on it (the marketplace) or have been working actively against” the Affordable Care Act, Pollitz said.
Nebraska Gov. Dave Heineman, a Republican, has said Obamacare won't work and should be delayed or repealed. Nebraska is among 21 states that so far have declined to expand Medicaid. Medicaid expansion is an element of the Affordable Care Act that was designed to get insurance to more low-income people.
Preston Love Jr., an Omaha community activist, is trying to spread the word in northeast Omaha about the marketplace. “It falls on those of us who are activists for our community to do more than we should” have to, he said.
Heineman has “put politics above policy and above the people” by resisting the Affordable Care Act, Love said.
Heineman's spokeswoman referred to Love as “a Democrat activist” and directed other questions about promoting the marketplace to Nebraska Insurance Director Bruce Ramge.
Ramge said his office won't be involved in marketing the program. “Our job is implementation and not promotion,” he said. Nevertheless, his agency will hold informational sessions this month in six communities, and more are expected in early October.
Meanwhile, marketing the marketplace in Nebraska rests with organizations such as Nebraska Appleseed and AARP, which also are holding educational sessions across the state.
Insurance companies that will offer plans in the marketplaces — Blue Cross Blue Shield of Nebraska, Coventry Health, CoOportunity Health and Health Alliance — also will promote the new method of enrolling.
CoOportunity, formed last year with startup money from Obamacare, in July held a flash mob, a kind of spontaneous gathering, in West Des Moines during RAGBRAI, the annual bicycle ride across Iowa.
The company also operated a booth at the Iowa State Fair and will promote itself at the River City Rodeo next week in Omaha.
CoOportunity's Lyons said reaching young people through websites and mobile applications on smartphones will be vital. “Social media will be important. Social interaction will be important.”
Cutler, who lives near Miller Park in northeast Omaha, said he makes $50,000 a year and will be looking for an adequate, economical health plan in October. Insurance is pricey, he said, but even though he's gone without it for more than a year, he hopes to get a good deal in the marketplace.
If there's an affordable option, he doesn't want to be uninsured when a problem arises. “That,” he said, “would be foolish.”