Reduced ACA Subsidies May Make It Harder for Young Adults To Afford Coverage

As they move into adulthood, many young Americans face a unique and daunting challenge: finding their own health insurance by the time they turn 26. The lucky ones are covered through their jobs. But in an age of gig employment, more are falling off the “26 insurance cliff” and landing hard.

For a project produced in partnership with The New York Times, my colleague Hannah Norman and I gathered statistics (where they existed) and asked young people to tell us their stories. And, boy, they did. The article clearly touched a nerve, gathering over 1,600 comments the day after it published.

Many of the young adults we interviewed for the article, like Elizabeth Mathis and Evan Pack, a couple in Salt Lake City, could afford their insurance only because of Biden-era premium subsidies for plans bought through the Affordable Care Act, which created federal- and state-based marketplaces where people can purchase health insurance. Those subsidies expire at the end of this year and, so far, Congress has shown little interest in extending them. If they expire, studies estimate, premiums are expected to rise 75% on average next year, and roughly 4 million people would lose coverage.

The cliff was an unintended byproduct of a part of the Affordable Care Act that allowed young adults to stay on their family plan until 26. That number was chosen somewhat arbitrarily, as an age when people should be able to afford standardized plans created by the ACA or go on Medicaid.

In many respects, the law was an immediate win for young adults, or at least an improvement over the prior state of affairs: Kids were commonly kicked off the family plan earlier, at 18 or 21, for example, and thrown into an open market where insurance products could exclude basic health needs, like reproductive care, and insurers could refuse to cover patients with preexisting conditions, like asthma.

Millions of young adults gained insurance who would have otherwise gone without. But in the intervening years, Republicans undercut many of the ACA provisions that helped form this safety net, and, today, 26 is the age at which most Americans are uninsured.

“The good news is that the ACA gave young people more options,” said Karen Pollitz, who directed consumer information and insurance oversight at the Department of Health and Human Services during the Obama administration. (Pollitz is also a former ACA expert for KFF, a health information nonprofit that includes KFF Health News.) “The bad news is the good stuff is hidden in a minefield of really bad options that’ll leave you broke if you get sick.”