Field Notes

Baccalaureate. In May, I watched my son Will and 597 fellow “millennials” graduate from Trinity College. They are part of the generation that grew up in the shadow of 9/11 (literally for my son, who saw the towers fall from his Brooklyn middle school windows), that witnessed and fought in two wars, that elected the first African American president, and that shrugs off gay marriage. If ever there were a “grown-up” generation, they are it.

Yet they’re graduating into tough times. According to the Department of Health and Human Services, young adults are the most likely group in the United States to have no health insurance. In 2008, almost 14 million—a third of the total uninsured—were between nineteen and twenty-nine years old. This group also has the least access to coverage. And, contrary to the belief that young folk are healthy, one in six of them has a chronic disease like cancer, asthma, or diabetes.

What are we doing for them? One of the immediate, and immediately touted, benefits of the hard-fought Affordable Care Act is the provision for young adults up to age twenty-six to be covered under their parents’ health care plans. This is progress, but hardly sufficient by itself. As employers shed health coverage almost as fast as they shed jobs in the Great Recession, just how many parents have coverage for their “children” anyway? (And isn’t there something disconcertingly infantilizing about referring to these full-fledged adults as “dependent children”?)

Indeed, the impact of the provision will likely be relatively small. The Departments of Health and Human Services, Labor, and Treasury estimate that approximately 1.2 million young adults will become covered under their parents’ policies in 2011—only 650,000 of whom are estimated to have been previously uninsured. This still leaves a lot of young adults facing a dismal job market without coverage. As I heard (on Facebook, of course) from my son’s friend Diane (Amherst ’09), who is working part-time at the Whitney Museum of American Art and does not have parents who can cover her, “I think the postgrad hunt for health insurance is really daunting. And I think a lot of freshly graduated students (especially these days) are taking internships and really low-paying jobs right out of college that definitely don’t come with benefits. I have one of the insurances that the city offers for people who fall under a salary threshold and aren’t covered by their jobs (it’s not exactly Medicaid, but definitely insurance for broke people).”

The sort of insurance she found is likely to offer considerably more coverage for millennials, while loosening the apron strings. According to a Commonwealth Fund analysis, the Affordable Care Act expands eligibility for Medicaid to all legal residents with incomes up to 133 percent of the federal poverty level (about $14,404 for a single adult). This might provide coverage for up to 7.1 million uninsured young adults. And subsidized private insurance like Diane’s could cover another 5.6 million uninsured young adults with incomes between 133 percent and 400 percent of poverty. Between that and the up-to-twenty-six provision, we might actually get somewhere.

“When it comes to this health care thing, I’ve found that people are getting really creative,” Diane wrote. Maybe one of the best features of the Affordable Care Act is that it frees our young adults to use their creativity to reshape a nation that sorely needs it.