Millennials are the key to the success or failure of the Affordable Care Act (ACA). The central component of the ACA is the individual mandate, which seeks to pool risk on a broad scale by requiring healthy young people to have health insurance. Advocates and detractors both agree that if millennials do not enroll, health insurance costs will skyrocket as an increasingly older and sicker insurance pool causes collective risk to balloon. In a troubling sign for the ACA, survey data collected by the Harvard Public Opinion Project (HPOP) shows that millennials not only disapprove of the ACA, but also believe that the health care law will increase their health care costs and impair the quality of their care.
The data from the survey demonstrates a striking rejection of the ACA by millennials under 30. The key demographic holds unfavorable opinions across the board on the Obama administration’s signature legislation. This result is remarkable given that millennials in the survey also identify by an 11-point margin as Democrats (43 percent) over Republicans (32 percent). The survey was split-sampled, with roughly half of respondents asked questions about “Obamacare,” and the other half asked about “the Affordable Care Act.” However, this article will use the numbers from the “Affordable Care Act” questions.
Only 39 percent of respondents in the HPOP survey approve of the ACA. This suggests that millennials are actually slightly more unfavorable toward the law than the broader adult population; a November 2013 Gallup survey found 40 percent approval and 55 percent disapproval of the law nationwide.
Meanwhile, millennials are even less supportive of the ACA when asked about specific effects of the law. A mere 17 percent of millennials believe the quality of their health care will improve under the law, with 44 percent responding that it will get worse and 36 percent expecting that it will stay the same. The bleakest millennial opinions are on health care cost. Only 10 percent believe that the ACA will decrease their health care costs, with 50 percent saying it will increase their costs and 36 percent expecting their costs to stay the same. These responses are especially interesting given that only 12 percent of millennials have an individual health insurance plan, while 35 percent are on a parental health insurance plan, and 27 percent have an employer-provided health insurance plan. Twenty-two percent of millennials do not have health insurance.
The consequences of millennials’ rejection of the ACA are underscored by the finding that only 20 percent intend to enroll in health insurance through an exchange. Conversely, nearly half (47 percent) do not intend to enroll, and another 28 percent are undecided about enrolling. Unless a significant number of millennials enroll in health insurance, health care costs will skyrocket. Then, even fewer healthy individuals will enroll, causing yet more cost hikes—a phenomenon known as a death spiral. Amid an otherwise grim picture for the ACA, one silver lining from the HPOP results may be that a large number of millennials are still persuadable. However, if these individuals come to reject the ACA in the same manner as many of their peers, the Obama administration will face problems much larger than a dysfunctional website.