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What Could King v. Burwell Mean for Young People?

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June 23, 2015

By Jeff Kubina.Simon Dodd via Wikimedia Commons [CC BY-SA 2.0}

By Jeff Kubina.Simon Dodd via Wikimedia Commons [CC BY-SA 2.0}

The Supreme Court is poised to release a decision on the King v. Burwell case any day. This case may have not received the attention it deserves for its possibly devastating outcome, especially for young people. Many people have discussed this case in terms of tax credits, something that young people may not think about very much. However, if the plaintiffs are successful, it would mean that any state using the federal government’s infrastructure for its healthcare exchange would not be able to receive federal financial assistance.

Currently, that financial assistance in the form of tax credits helps low- and middle-income people pay their monthly insurance premiums. Without that assistance, monthly payments will increase substantially. For example, in Alabama where the average monthly insurance payment in 2013 was $178, that amount could go up 321%. That could make a monthly payment $571.00. The average monthly rent in Jefferson County Alabama is anywhere from $500-$700.  That means someone’s health insurance could cost almost their entire monthly housing budget.

We will let that sink in for a minute.

Young people, or the young invincibles as they are commonly referred to, are a critical part of the “affordability” part of the Affordable Care Act (ACA), and critical to any functioning insurance market. If healthy young people are not purchasing insurance and participating in the marketplace, older folks who tend to have higher health-related costs will make up most of the  market, and prices go up for everyone.

Thanks to the ACA, people under 26 can stay on their parents’ health insurance plans. This is great, but it does not make young people who fall in that category immune from the effects of a bad decision in King. First, not all young people have parents who have employer-provided insurance or who are able to afford private insurance. These young folks are either on Medicaid (but only states that have expanded eligibility) or need to purchase health insurance on an exchange. All of the states that have not expanded Medicaid operate federally facilitated marketplaces, which will be impacted by the King v. Burwell decision. Only 7 states that run federally facilitated marketplaces have expanded Medicaid.*

Second, young people are more likely to work low-wage or part-time jobs, and therefore have employers who are not required to provide health insurance to their employees. Young people areare more likely to be in the “coverage gap,” meaning they don’t qualify for public assistance and also have a hard time affording insurance premiums.

If you are a student, it might be possible to qualify for Medicaid if your parents don’t have insurance–but it would not be a reality for most students. Many states have not expanded Medicaid eligibility to young adults without disabilities or without children. In those states, only these so-called “deserving poor” can qualify for Medicaid coverage, that excludes most students.Therefore, in non-expansion states (states that will be hardest hit by a bad King decision), full-time students can’t get public assistance and will have to use income from student loans to buy health insurance either from their university or on an exchange. As recent law school graduates, we can assure that you that the cost of a monthly insurance premium is only going to add to your already gargantuan student loan debt.

The issue brought before the Supreme Court rests on 5 words: “exchange established by the State.” In the argument before the Supreme Court, Justice Scalia asked the attorney for the government who was defending the ACA, “You really think Congress is just going to sit there while all of these disastrous consequences ensue?” The lawyer, without missing a beat, responded “this Congress?” There was laughter in the audience. This attorney makes a good point. It is possible that the entire ACA could crumble over something as simple as a single phrase. Because we know this Congress won’t fix it.

We have a Congress that many young people feel does not represent them. Not in values or our priorities for ourselves or the future. We have to pay attention to the Court’s decision in King v. Burwell and be prepared to mobilize to save insurance affordability if the ACA falls apart around us.

Written by Kelsey Ryland, URGE Law & Policy Fellow

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