Young Invincibles Hails Unanimous Passage of Perkins CTE Bill out of House Committee


Thursday, July 7, 2016

CONTACT: Nina Smith,, 301-717-9006

Washington, D.C. — Today, the U.S. House Committee on Education and the Workforce passed out of committee HR 5587, the Strengthening Career and Technical Education for the 21st Century Act, a bill designed to reauthorize the Perkins CTE program. The 37-0 vote advances the bill to the House floor. Perkins CTE allows states to fund robust career and technical education programs in high schools and community colleges, and enables students to get the training they need to prepare for future careers. Reauthorization of the program is an opportunity to advance reforms to help young Americans find work, as detailed in Young Invincibles’ Millennial Workforce Development Priorities Report.

“We celebrate bipartisan committee passage of a modern Perkins program that works better for young people. This bill is an important step toward creating a program that is responsive to the needs of employers and young workers alike,” said Reid Setzer, Young Invincibles’ Policy and Legislative Affairs Analyst. “Aligning Perkins with other federal workforce programs and improving the metrics used to evaluate success will strengthen the program long-term and help relieve high youth unemployment. We look forward to Congress continuing their work on improving aspects of Perkins on the path to reauthorization in the coming months.”


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Young Invincibles’ Statement on Covered California’s October Numbers

November 21, 2013

Contact: Riana King, riana.king@younginvincibles.org213.221.7326

Young Invincibles’ Statement on Covered California’s October Numbers

Over 30,000 Californians Have Already Enrolled in Health Plans Set to Begin Coverage in January 2014

[SACRAMENTO, Calif.]—According to a report from Covered California, 30,830 Californians have enrolled in private health plans using from October 1st to November 1st. About one in four of those who enrolled were young adults age 18 to 34.

Linda Leu, California Policy and Research Director at Young Invincibles, released the following statement on today’s announcement:

“Today Covered California announced that 30,830 Californians were able to enroll successfully during the first month of open enrollment. Young Invincibles is especially excited that about one in four of the new enrollees are young adults, showing that young adults are engaged and excited about their new options even at this very early stage in the enrollment process. We learned from the Massachusetts experience with health insurance reform that enrollment numbers will continue to grow as consumers learn more about their various options and as we get closer to the deadline—March 31, 2014. We will continue to work to make sure that young people are getting the information they need about their new coverage options, and that they are enrolling successfully.”

“With 31 percent of young Californians lacking insurance, the Affordable Care Act could truly improve the lives of millions of young adults in California alone. Young adults throughout the state have told us that they want health insurance, but simply have not been able to afford it. Thanks to the provisions of the Affordable Care Act and Medicaid expansion in California, millions of young Californians will have access to quality and affordable health options. We are excited that young people are exploring their new options, and we look forward to continuing our outreach efforts here in California.”


Young Invincibles is a national organization committed to amplifying the voices of young adults, ages 18 to 34, and expanding economic opportunity for our generation. Young Invincibles ensures that young adults are represented in today’s most pressing societal debates through cutting-edge policy research and analysis, and innovative campaigns designed to educate, inform and mobilize our generation to change the status quo.

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Young Invincibles: What’s In a Name?

By Tobin Van Ostern and Spencer Dixon

The myth still lives on. Health policymakers and pundits continue to call our generation ‘young invincibles,’ the term that derives from the ill-conceived theory that young people choose not to purchase health insurance because they think we don’t need it. The term makes sense, since young people don’t care about health, right?  There’s only problem with that theory: it’s wrong– and we have proof.

Check out Resonate’s infographic below:


The data from the Resonate study tells a completely different story than the myth told by many health pundits. For example, when researchers asked young adults without health coverage why they were uninsured, the most popular reason cited was because they couldn’t afford it, not because they didn’t want it.  Three times as many young adults (35%), cited high costs as the reason they don’t have health insurance, in contrast to those who didn’t because they thought they didn’t need it (11%).   Previous research done by Young Invincibles and others confirms this finding.

The traditionally higher cost of health insurance and the lack of employee benefits available to young workers has made health insurance unattainable for too many young adults over the past years.  But over the coming years, as many as 17 million currently uninsured young adults could be eligible to enroll in free or discounted insurance plans.  These changes start to roll out on October 1st.

But to take advantage of these new options, young adults need to get informed about these benefits and get enrolled. Unfortunately, not many young people know about their new options. Almost one third (30%) of all young adults 18-34 are completely unaware that new marketplaces will be opening for enrollment on October 1st.

So, what can you do? First, if you or any of your close friends are uninsured, plan to sign up starting October 1st. Second, be a part of the solution by letting other young adults know of their options under Obamacare. If you could get quality, affordable coverage that could save your life, wouldn’t you want to know about it? With your help, we can take advantage of this opportunity and insure millions of young adults. Let’s get to work!

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What Good is Having Insurance If You Don’t Feel Safe Using It?

Guest Blog by Aileen Connolly

Thanks to the Affordable Care Act, over 435,000 young adults in California now have health care coverage because they can stay on their parents’ health care plan until the age of 26. As a result, confidentiality is now more important than ever. When young adults get health services like STI treatment, birth control, drug treatment, and mental health services, the sensitive health information is shared with the policyholder through an Explanation of Benefits (EOBs) letter. But sometimes, young adults can’t talk about these sensitive health services with their parents. And even if they are close with their parents, shouldn’t this information be shared when young adults are ready, instead of an insurance company disclosing their personal health care choices?

Not being able to guarantee confidentiality can lead to harm. Last semester, I went to my OB/GYN for a pregnancy test. Luckily it was negative. However, I still wasn’t totally in the clear: I had no idea that insurance companies reveal to policyholders what services their dependants have during doctor appointments. I was hoping that my parents would never know or that I could tell them when I was ready.  But my parent’s insurance provider told them before I had a chance to, through an “Explanation of Benefits” letter. When the letter came, my mom was shocked, thinking it was some sort of mix-up with our insurance provider. She called me asking me what day my OB/GYN appointment was and if I had taken a pregnancy test.  In my mind, I was thinking, “how did she find out, did my doctor break confidentiality?”

When the insurance company told my mom about my pregnancy test, it hurt my relationship with my parents.  Luckily, a bill in California can expand confidentiality protections so this incident won’t happen to other young adults. Introduced by Senator Hernandez, SB 138- the Confidential Health Information Act will: 

  • Enhance patient confidentiality to make sure that people with private health insurance under a parent or partner’s policy feel safe enough to use it.
  • Close loopholes and clarify definitions in existing state and federal laws to allow individuals to submit a request to insurance plans to send communications directly to them and not the plan holder when they seek sensitive services.
  • Allow individuals seeking any service to request non-disclosure to the plan holder if they feel doing so could endanger them. This is especially important in cases of domestic violence.

Bills like this one will allow young adults to have access to mental health services, birth control, and substance treatments without fear that a parent will find out about it, saving out-of-pocket and state costs along the way. Right now SB 138 is waiting to be heard in the Assembly Appropriations Committee and will hopefully make its way to the Assembly floor in September. I hope you’ll join me in fighting for the Confidential Health Information Act. Take Action:

Aileen Connolly recently finished her Public Policy Internship at California Family Health Council. 

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Obamacare enrollment efforts, and message wars, heat up

July 25, 2013 in Ledger Inquirer; cross-posted on July 26, 2013 in Bradenton Herald

by Tony Pugh

WASHINGTON — Amid a resurgent effort by critics to attack the new health care law, the Obama administration and its allies are focusing on getting millions of Americans enrolled in coverage next year and making sure the new state health insurance exchanges will be ready for open enrollment in October.

But convincing a skeptical public to heed the Affordable Care Act’s “individual mandate” will be a major challenge when the bulk of the health care overhaul is fully implemented next year.

Polls show that not only do most Americans dislike the provision that requires them to get health coverage or pay a fine for noncompliance, but they’re also confused about what coverage they should get, how to get it and how much it will cost.

To better inform people of their options, nearly 1,200 community health centers will use $150 million in federal grants to help spread the word. Florida Community Health Centers, for instance, which operates 10 facilities in central Florida, will use its $173,000 grant to hire three full-time benefit counselors and an outreach worker who’ll seek out the uninsured for coverage .

“We go to beauty shops, barbershops, day cares, laundromats, churches and any other houses of worship. That’s where people congregate,” said Molly Ferguson, the centers’ director of program development.

These and other federal grants will help with outreach efforts, but congressional Republicans’ refusal to provide more money for a public awareness campaign has made the enrollment effort more difficult. The health care law was passed in 2010 without Republican support.

Private Obama-friendly organizations such as Enroll America, Young Invincibles and Organizing for America will be counted on to help the administration try to win the health lawmessaging war. But opponents of the law have been on the offensive.

A recent analysis by Kantar Media, which tracks political spending, found that critics of the Affordable Care Act have spent $400 million on television ads since the law passed, compared with just $75 million by Obamacare supporters.

A $1 million anti-Obamacare ad campaign by Americans for Prosperity, a conservative political group funded by billionaire Kansas industrialists Charles and David Koch, is airing online and on cable networks in Ohio and Virginia.

“We feel it is important to educate Ohioans on the true consequences of government intrusion into the private health care decisions of families,” said Eli Miller, the Ohio director of Americans for Prosperity.

The conservative Citizens’ Council for Health Freedom has launched a national “Refuse to Enroll” campaign that urges people not to buy coverage through the exchanges.

The council, which describes itself as a “free-market resource” for health care issues, says the cost of coverage on the exchanges might be unaffordable for many, even with premium subsidies. The group claims, among other reasons, that the exchanges will offer only limited choices of physicians and hospitals and that they require considerable paperwork to enroll. It likens them to “Medicaid for the middle class.”

“We encourage Americans to get involved and make sure that the exchanges fail and, as a result, Obamacare also fails,” said Twila Brase, the group’s president and co-founder.

In response, the left-leaning Americans United for Change will launch a “Hands Off Obamacare” ad campaign on cable news stations beginning next week.

In the face of dwindling funds and a powerful negative messaging machine, the Obama administration and a variety of public and private stakeholders will try to enroll an estimated 7 million people for coverage on the exchanges from October to March.

“We know it won’t be easy,” Health and Human Services Secretary Kathleen Sebelius said recently. “So many Americans have spent their whole lives being frustrated, gouged or turned away by our health care system, and connecting them with information they need to finally get quality affordable coverage is a huge undertaking. But the challenge of enrollment pales in comparison to the benefit that millions of American families stand to gain. And that’s why we’re doing it.”

President Barack Obama, who’s faced criticism for failing to personally embrace and sell his signature piece of legislation, took a decidedly stronger tone earlier this month, when he announced that 8.5 million Americans had begun receiving average rebates of $100 apiece, due to a provision in the law that penalizes wasteful spending by insurers.

“Our broken health care system threatened the hopes and the dreams of families and businesses across the country who feared that one illness or one accident could cost them everything they’d spent a lifetime building,” he said. “And step by step, we’re fixing that system.”

Sebelius said the health center grants would pay for nearly 3,000 outreach workers who’d help an estimated 3.7 million people sign up for coverage.

Florida Community Health Centers hopes to assist 3,000 people a year through its grant, and Ferguson expects about 2,500 of them to be eligible for services through the health care law. Word-of-mouth may be the group’s most effective recruiter.

“If you get one family (enrolled), you can be sure everybody in their neighborhood will know about it before the end of the day,” she said. “Our patients are our best advertisement. They tell the story better than anybody.”


HHS also has awarded $32 million to 41 state agencies, health centers and nonprofit groups in 22 states to help enroll eligible children for coverage in Medicaid and the Children’s Health Insurance Program.

California Coverage & Health Initiatives, a statewide community and children’s health outreach and enrollment network, received a $751,000 grant to enroll uninsured Latino children in the state’s Central Valley and Inland Empire regions, where many Medicaid-eligible Latino children don’t have coverage. It’s a long-standing problem with many causes, including a lack of state resources to address the problem and a reluctance by Latinos of varying immigration statuses to seek government benefits.

“We see this persistent problem of families not aware that their children are eligible for coverage,” said Suzie Shupe, the network’s executive director. “So while our organizations have worked hard to (enroll them), it has been challenging.”

The group hopes the grant will help enroll 6,000 to 10,000 Latinos in some level of coverage.

“All of the media campaigns and outreach and education campaigns that are going on with the coming open enrollment is a great opportunity to really educate Californians about coverage that’s available and to get to those families that we haven’t reached before,” Shupe said.

Next month, HHS will award grants to “navigators,” the individuals and organizations that will educate the public about the exchanges, provide impartial information about available health plans and explain the premium tax credits that will help individuals purchase coverage.

But the navigator programs will be grossly underfunded in states where the federal government will run the insurance exchanges, because Congress has refused to allocate more money. Just $54 million will go to those 34 states to assist millions of people who often don’t know about the new laws, have never had health insurance and are unfamiliar with how to purchase it.

States with the most uninsured residents will get the bulk of the money, but 13 states will receive only the minimum $600,000 grants.

When Sebelius sought contributions from businesses to help fund outreach efforts by the private nonprofit group Enroll America, congressional Republicans launched an investigation, accusing her of violating the appropriations clause of the Constitution.

At a recent discussion about the Affordable Care Act at the National Press Club in Washington, Earl Pomeroy, a former North Dakota Democratic congressman and state insurance commissioner, said the GOP tactics were par for the course.

“Politics again is weighing in on this,” he said. “I think a cynic could say you’ve taken efforts at voter suppression and we’ve moved them right over to efforts at enrollment suppression. . . . This is really about trying to, first of all, discourage the contributor universe and discourage any administrative efforts to raise privately what they could not get funded publicly, to the end that we don’t really want people to know about these exchanges.”


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The White House Is Optimistic About Its Limited Obamacare Goals

July 18, 2013 in The Atlantic

by Garance Franke-Ruta

Only half the nation’s governors have signed onto the Medicaid expansionunder the Affordable Care Act and the bill’s employer mandate has been delayed for a year, but the White House remains confident about its ability to make the state-based insurance exchanges that are a central part of the Obamacare roll-out a success.

In this, its optimism is reminiscent of that of the Obama reelection campaign during the late summer and fall of 2012, when the people running the microtargeting and ground operations expressed assurance about their efforts even in the face of polls that raised doubts about the president’s prospects. That’s not too surprising, as the White House team conducting the roll-out in conjunction with the Department of Health and Human Services involvespollster David Simas, the former director of opinion research for the president’s reelection campaign and since earlier this year a top communications and strategy aide in the White House. He is now operating with similar Census-tract-by-Census-tract targeting care to figure out how to find and sell insurance to uninsured 18-to-35-year-olds who want coverage and are eligible for subsidies under the new law, which goes into effect on January 1.

The exchanges, or Health Insurance Marketplaces, are regulated, competitive regional markets that offer a range of plans that meet certain baseline standards, into which people will be funneled through a central website and application form. The key to getting them up and going is enrolling enough healthy people between 18 and 35 to make the risk pools work and keep rates competitive for the older, sicker people who will be drawn to the new insurance options. Insurers need young healthy people in the pool to keep rates lower for everyone; if only older, sicker people buy insurance at the outset, the calculus behind expanding health-care coverage through a private-sector market falls apart, because rates won’t stay low enough for ACA subsidies to help low- to low-middle-income people afford insurance long term.

Here’s how the White House expects this to go, according to a recent briefing by Simas and conversations with other White House officials. All numbers are from a PowerPoint developed by Simas, unless otherwise specified.

* The vast majority of Americans already have health insurance, primarily through their employers.

* But there are 15.4 people in the individual insurance market, and there are 40 million people who are uninsured.

* These are the people who presumably would be open to turning to the health-insurance exchanges to seek either better options for insurance, or novel insurance options.

* The first year enrollment target for the exchanges nationwide is 7 million, to be enrolled between October 1 of this year and the end of March 2014.

* For the marketplaces to work, 2.7 million of those 7 million applicants have to be between 18 and 35.

Of the uninsured between 18 and 35, 57 percent are male, and 43 percent are female. Almost all — 96 percent of them — have no chronic conditions (compared only half of those between 55 and 64). Slightly over half of them are minorities — 52 percent — and 48 percent are white.

Of those between 18 and 34 who don’t have insurance, cost is the main reason preventing them from having it, stymieing 52 percent, according to June’sKaiser Health Tracking Poll. Only 17 percent of the uninsured in this group say they simply chose not to get insurance.

A third of the uninsured have to be enrolled in just three states — California, Florida, and Texas — to hit the national number targets, but the risk pools have to be balanced internally in every state, since these are state-based markets. For the purposes of building the risk pools, it doesn’t matter whether or not a state has accepted or refused the ACA’s Medicaid expansion, because there are enough uninsured people eligible for insurance subsidies — the tax credits provided for by the law — that even without the Medicaid expansion, the numbers can be met if about 20 to 25 percent of the cohort of uninsured, credit-eligible 18-to-35-year-olds can be signed up for the exchanges. (There are 19 million uninsured between the ages of 18 and 34, according to the advocacy group Young Invincibles, about 9 million of whom are likely subsidy-eligible.) The exchanges will be open in every state and the District of Columbia.

Again: The entire 2.7 million 18-to-35 cohort could be made up of people eligible for subsidies. It also could be made up entirely of minorities. It could even be made up entirely of women (only 11 percent of whom say they choose not to have insurance, compared to 22 percent of men). The size of the uninsured 18-to-35-year-old population is large enough in comparison to the first-year enrollment goal that any talk of sabotage by healthy young people refusing to sign up because of political opposition to the law is laughable. The cohort could even be made up almost entirely of people who live in cities — cities governed by Democrats who have an interest in making sure their constituents get access to the new federal program. In Texas, that means people like the mayors of Dallas, Houston, and San Antonio.

Messaging on the exchanges will be rolled out through media that’s been determined to be likely to reach the uninsured, such as: Galavision TV (a division of Univision), BET, MTV, G4SpikeOxygenStyle, and women’s magazines, such as Cosmopolitan, which has the largest circulation in the category. It will involve six months of targeting of pockets of the uninsured in 19,000 American cities and their surrounding areas. Women — moms and girlfriends — are expected to be critical drivers of opinion on enrolling in the new plans, as women are already one of the major forces behind men taking the time to go to the doctor, lose weight, get that mole checked out, and so on.

The central messaging will involve cost, since that’s been the biggest stumbling block for the uninsured: finding a plan to fit your budget. Because there are no longer any pre-existing condition bans, there will no longer be an underwriting period when people apply for insurance. The enrollment website will show people the cost of each plan in their area, the amount of federal subsidy they are eligible for, and the final discounted price they would pay per month, depending on what plan they choose.

Republicans have expressed concern that without the employer mandate and income-verification requirements, implementation of which have been delayed,the subsidy enrollment system is open to fraud, but supporters of the bill insist than any discounts people get that they are not eligible for will result in a bill from the IRS on the other end.

The White House and Obamaland folks have previously made a lot of predictions. Some of them — like Joe Biden’s off-the-cuff 2010 prediction that there’d soon be 250,000 to 500,000 jobs created per month — have turned out to be wildly off the mark. Others, like the more data-driven predictions about the 2012 election, have been remarkably accurate. It will be interesting to review the hopes of July 2013 in the spring of 2014, and see which category the current ambitions fall into.

Even if 2.7 million young people do enroll and 7 million enroll overall, there will be tens of millions of uninsured as the administration heads into year two of the meat of the Obamacare roll-out. The White House keeps saying that the new health-care law will become more popular as more and more people begin to benefit from it. But it’s an open question whether the pace at which it’s realistically possible to transform the health insurance system is fast enough to make that opinion shift happen any time soon.


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Obama’s last campaign: Inside the White House plan to sell Obamacare

July 17, 2013 in The Washington Post; re-posted July 19, 2013 in Bangor Daily News

by Ezra Klein and Sarah Kliff

Deep inside the White House, in a bare room that the chief of staff uses for meetings, David Simas is still thinking about turnout.

Turnout has been Simas’s job for years now. As director of public-opinion research and polling for President Obama’s reelection campaign, Simas was at the center of the effort to find and persuade young and minority voters to go to the polls like they did in 2008.

Many doubted the Obama campaign’s contention that it could recapture the 2008 electorate. Simas’s data, however, convinced the campaign that was possible. And when the smoke cleared, young voters and minorities did show up to the polls, and Obama won.

Now Simas, a sad-eyed Massachusetts native with a facility for PowerPoints, needs to reach those same groups again — with a much harder ask. This time, he doesn’t just need them to vote. He needs them to buy health insurance, and, in some cases, spend hundreds of dollars a month for it. If they don’t, the new insurance marketplaces — the absolute core of Obamacare — will be filled with older, sicker people, and premiums will skyrocket. And if that happens, the law will fail.

The debate over Obamacare often focuses on the law’s complexity. Senate Minority Leader Mitch McConnell (R-Ky.) has taken to pushing around a seven-foot stack of paper showing the tens of thousands of pages of regulations it has spawned. Senate Finance Chairman Max Baucus (D-Mont.) has warned that implementing such an intricate statute could be a “train wreck.”

But to the White House, the difference between success and failure is straightforward: They need to entice a sufficient number of young and healthy adults into the new insurance marketplaces that open Oct. 1.

How many younger people are needed each year to hold down premiums depends on how many people sign up for the marketplaces. If the total this year is 7 million people, then about 2.7 million need to be in the 18-to-35 set.

This, then, is the crux of Obamacare’s challenge: Can the federal government persuade young, healthy people to buy health insurance?

Simas is focusing his formidable analytical resources on understanding this group. He begins clicking through a Powerpoint that holds reams of data on these young adults. “What do we know about them?” he says. “They’re overwhelmingly male.” Click. “They’re majority nonwhite.” Click. “One out of every three lives in California, Florida or Texas.” Click. “We have census maps breaking this down into the smallest geographic units.”

A couple more clicks and Simas is showing which television channels they like to watch (Spike TV, among others), which social-media platforms they use (Twitter, Facebook) and who they listen to (“No surprise. It’s mom.”). “We can figure out the message that works best for this group,” Simas says.

The focus on young, minority voters. The heavy reliance on microtargeting. The enthusiasm about nontraditional communications channels. The analytics-rich modeling. It sounds like the Obama campaign. And administration officials don’t shy away from the comparison.

“When I hear the conventional wisdom about Obamacare,” said Jeanne Lambrew, deputy assistant to the president for health policy, “this is the difference between the Karl Roves who put their fingers to the wind and the Nate Silvers of the world who looked at the numbers.”

But the effort will have to go far beyond engineering turnout among key demographics. The administration needs to build more insurance marketplaces than they ever expected, and create an unprecedented IT infrastructure that lets the federal government’s computers seamlessly talk to the (often ancient) systems used in state Medicaid offices. They need to fend off repeal efforts from congressional Republicans — like Wednesday’s vote to delay the individual mandate — and somehow work with red-state bureaucracies that want to see Obamacare fail. And they can’t escape the fact that the law, three years after passage, remains stubbornly unpopular.

Amid these challenges, critics say the administration is simply defining success down. “Their job in 2013 is to declare victory in any way possible,” said Doug Holtz-Eakin, president of the conservative American Action Forum. “They’ll keep moving goal posts until they can declare victory.” Holtz-Eakin noted that the administration has recently delayed significant parts of the bill, like the employer mandate. “It’s an admission that the whole thing can’t be implemented,” he said.

Over the course of three months and in dozens of interviews for this article — with Obama administration officials, state-level implementers, outside experts, steadfast critics and others — two distinct and contradictory views emerged: One, of confident Obama administration officials focused on building its marketplaces and ignoring the naysayers in Washington, who they believe simply don’t understand the law. Another, of Obamacare’s increasingly confident critics, who believe the law is collapsing under its own weight and feel themselves more vindicated by the day.

Caught between those two sides are the state-level bureaucrats and technology consultants who have 76 days left to set up the biggest health-coverage expansion in decades.

“In 2011, there was this ‘we’re going to save the world’ mentality,” said Rebecca Pearce, executive director of the Maryland Health Benefit Exchange. “In 2013, it focuses more on ‘How do we deliver on the requirements of the law?’”

‘Advocates on the ground are really struggling’

It wasn’t supposed to be easy. But expanding coverage to millions of Americans wasn’t supposed to be this hard.

When Obama signed the law in March 2010, legislators envisioned the health-care overhaul as a partnership between state and federal governments. States had served as the primary regulators of insurance markets for decades, so there was widespread expectation they would want to operate the new insurance exchanges, too.

One internal White House memo, drafted by two health policy advisors a few months before the Affordable Care Act, detailed the major hurdles in implementation. It fretted over the law’s tight timelines — which have indeed forced mulitple delays — and the possibility that insurers would hike prices before new regulations took effect. It never mentioned political opposition or widespread state resistance.

The White House never predicted that only 16 states and the District of Columbia would run their own health insurance exchanges, leaving the federal government to set up the majority of marketplaces.

Nor did it foresee the Supreme Court decision allowing states to opt out of the Medicaid expansion, a provision of the Affordable Care Act designed to extend coverage to 17 million Americans, fully half the total number of uninsured expected to be covered by the law. Fewer than half the states have decided to pursue the Medicaid expansion.

The White House figures that the rest of the states will come around soon enough, especially if the law is a success — and the administration expects that the marketplaces will drive that judgment. And so officials obsess over their construction — and anything that might stand in their way.

In recent months, White House has begun delaying high-profile parts of the law that officials believe will interfere with their ability to set up the marketplaces. They put off enforcing a requirement that all large employers provide coverage to full-time workers, and, on the Friday following the Fourth of July, quietly released a 606-page regulation that delayed requirements for the marketplaces to verify workers’ incomes and employment status.

Even the most tuned-in health-care consultants have trouble predicting whether the federal government can get the law off the ground.

“It’s pretty much a black box,” Deloitte’s Cheryl Smith said of the technology that powers the health law. “They tell us, ‘It’s freakishly on schedule.’ They use those exact words. But only the people who work in this can tell you if it’s actually running on time.”

In states that refuse the Medicaid expansion, residents whose incomes are above the poverty line ($11,490 for an individual) will still have access to tax credits for purchasing private insurance on the exchanges. Those below the poverty line, however, will not receive help obtaining coverage. That lessens the law’s reach, and creates an unexpected messaging problem: How does the White House tell certain citizens that they earn too little to qualify for any help?

“How do you explain this in a way that seems fair and reasonable, that the higher-income people get help but you don’t?” said Mike Perry, a founding partner at polling firm PerryUndem Research. “Advocates on the ground are really struggling with that group. They want to have a positive message but don’t know what to say.”

Perry and his co-founder, Tresa Undem, have arguably conducted the most extensive research on encouraging insurance enrollment under the law; in April, Undem conducted a briefing for administration officials on how best to reach young Americans.

They have found, overwhelmingly, that Americans are uninformed about the health law — and are deeply skeptical when they learn about it.

When they asked in a recent survey whether a $210 premium was affordable, only 29 percent of likely marketplace enrollees said yes. Then, Undem and Perry phrased the question a bit differently. They told the focus group participants that, with their tax credits, they would save “$1,908 a year compared to what you would pay on your own.”

All of a sudden, 48 percent of the participants thought that insurance was affordable. But 48 percent is still less than half.

‘He knows how to get people out’

Aaron Smith runs the Young Invincibles, a group dedicated to enrolling young adults into health insurance coverage. (D.A. Peterson for The Washington Post)

The Obama administration believes it has four ways to pull people — both young and old — into the market. There are the subsidies. There’s the individual mandate. There’s the hoped-for ease and transparency of the new marketplaces. And then there’s the fact that people want health insurance.

Aaron Smith is a 31-year-old who runs the the group Young Invincibles, which advocates for the health-care interests of younger adults. The name is taken from the insurance industry term for young adults who don’t purchase insurance because they’re confident nothing will happen to them. “That term was really insulting to us,” he said.

Polling shows that young adults overwhelmingly want health insurance, and their behavior backs that up. When they’re offered health coverage through their jobs, studies show more than 60 percent take it — which is similar to the take-up rate among older adults. But young adults are less likely to have jobs that offer affordable insurance. “I think people just dramatically underestimate how hard it is for someone who doesn’t get health insurance at their job to get health insurance,” Smith said.

The result is slightly paradoxical: Young adults are the cheapest group to insure but the group most likely to go without insurance. The reason, put simply, is that young adults are likelier than any other group to be poor. Smith calculates that 19 million young adults between 18 and 34 lack health insurance. Under Obamacare, 8 million of them will qualify for free insurance through Medicaid. An additional 9 million will qualify for subsidized insurance in the exchanges.

In fact, the vast majority of the young adults expected to be in the marketplaces are expected to qualify for subsidies. Linda Blumberg, a health-policy analyst at the nonpartisan Urban Institute, has done extensive work modeling who is likely to sign up for insurance on the exchanges. She estimates that 96 percent of 21- to 27-year-olds will get some income subsidies.

Some young adults won’t find Obamacare a good deal, however. Because the program ends discrimination against the sick, limits it against the old and puts certain quality requirements on insurance, some healthy, young, not-that-poor people in the exchanges will find their premiums rising — a phenomenon known as “rate shock” in health-policy circles.

That’s why Congress added the individual mandate. Beginning in 2014, anyone who can afford insurance — which is defined as having access to health coverage that costs less than 8 percent of income — but chooses to go without it has to pay a fine. The penalty is far less than the cost of insurance: It starts at $95 in 2014, then ramps up to $695 in 2016, or 2.5 percent of income, whichever is greater. That raises the possibility that some might choose to pay the penalty and then simply sign up for insurance at some later date when they get sick.

But the experience in Massachusetts, which structured its overhaul in a similar way, suggests few will choose to pay the penalty. There, rates of uninsurance for young adults have fallen to the low single digits. “The idea of paying a penalty and getting nothing is more distasteful than paying more to get insurance,” said Gary Claxton, director of the Health Care Marketplace project at the Kaiser Family Foundation.

The question is whether Massachusetts offers much of a guide. The state is relatively rich, fairly liberal, and Republicans, Democrats and the business community all worked together to implement the health-care exchanges. There were even ads featuring members of the Boston Red Sox — and nothing like the organized opposition facing Obamacare.

“The zeitgeist was very different,” said Kevin Counihan, who ran Massachusetts’ health law marketing in 2006. “We’re in an environment [now] where 40 percent are against it, 35 percent are for it and neither side knows what’s actually in it.”

That opposition is a wild card to the researchers trying to predict whether the exchanges will succeed. Blumberg and Claxton have both tried to model enrollment in the marketplace and found the exchanges should be relatively successful, lowering average premiums and attracting a diverse group of insurance buyers. But they’re cautious, as they worry that the controversy around Obamacare may make past consumer behavior a poor guide to the law’s future.

“What’s not in the modeling is the institutions,” Claxton said. “How hard does the insurance department or Medicaid department in a red state make it to implement this?”

This is where Obama officials say their campaign experience — and their candidate — gives them an advantage. The profile of the people they’re trying to entice into the exchanges almost perfectly matches the profile of Obama voters. And they are confident they know how to talk to those voters.

“If we were having this debate last year, the pundits would be saying that ‘it’s not clear Obama will get young people out to the polls again, it’s not clear if African Americans will turn out to vote’,” said Nancy-Ann DeParle, the former head of the White House Office of Health Reform and deputy chief of staff to Obama. “Well, guess what? As Barack Obama has repeatedly shown, he knows how to get people out. And I think they will turn out to enroll in health plans just as they did to vote last November.”

‘I know it’s hard’

Jeanne Lambrew, special assistant to the president on health policy, has worked on the Affordable Care Act for years. (Lance Rosenfield/Prime)

On paper, the marketplace looks like a smooth glidepath to insurance coverage. In practice though, building the technology to power these massive data systems is the health law task where outside observers could most easily see the administration failing.

“Everybody is having sleepless nights given the magnitude of the effort and the short amount of time,” said Kevin Walsh, a senior executive at Xerox working with multiple states on health plan implementation. “It’s like building a bridge from both ends and hoping, in the end, they connect.”

When Walsh wants to explain the administration’s massive challenge, he uses a one-page flowchart that outlines eight steps, six government agencies and the back-end technology involved in getting someone enrolled.

There are three rows of boxes highlighting crucial actions: Information the federal government needs to verify, or a step a consumer must take. The chart is meant to simplify, but it has so many arrows — pointing up, down, left and right — it hurts just to look at it.

Behind all those boxes sits perhaps the most difficult and technical task of health reform: The construction of the federal government’s massive data hub, an unprecedented trove of income, citizenship and personal information about millions of Americans. This is the engine that will power federal decisions about who qualifies for which health law programs. If it doesn’t work, neither does the rest of the health care law.

The administration has recently scaled back the hub’s workload for the first year. It won’t help states verify applicants’ claims that they do not receive employer- sponsored insurance, for instance. When a consumer claims to have an income wildly different from what the federal data hub suggests, the marketplace, in most cases, will take the consumer’s word for it.

“I read that as an admission that not all of the components of the hub are working,” said Sara Rosenbaum, a health-policy researcher at George Washington University who supports the law.

Over the course of the year, states across the country have put off parts of the law that they hoped would be ready by October. The inspector general’s office at the Internal Revenue Service warned in mid-July that the federal government may still be testing the system when it opens enrollment, creating “significant delays” in processing applications.

State bureaucrats often lay blame at the federal government for repeatedly changing the requirements.

“Some of the guidance from the federal government is still coming,” Mila Kofman, director of the DC HealthLink, said. “That means we can’t get to our wishlist.”

Hundreds of federal workers are racing to ensure that the hub is ready by Oct. 1. In May, Obama called these employees to congratulate them on work accomplished so far–but also to commiserate.

“I know it’s hard, it’s a lot of work,” he told them. “It’s very rare in the annals of American history where we have to set up something this quick. And let’s face it, it’s not as if the political environment has always been friendly in terms of getting this stuff done.”

‘The train is doing a little better’

Speaker of the House John Boehner (R-Ohio) stands next to a printed version of Obamacare during a news conference on May 16. (Photo by Chip Somodevilla/Getty Images)

Obama has already predicted that mistakes will be made in setting up the health law.

“Even if we do everything perfectly, there will still be glitches and bumps,” he said at an April press conference. “That’s pretty much true of every government program that’s ever been set up.”

It was certainly true of the federal government’s last major health- insurance expansion, Medicare Part D.

Months before it launched in 2006, Medicare Part D was less popular than today’s Affordable Care Act — 21 percent of the public viewed it favorably while 66 percent did not understand how it would work.

The rollout was a disaster. Some seniors who earned too much to qualify for subsidies received them anyway. Some low-income enrollees who should have received financial aid didn’t. On “Fox News Sunday,” then-House Minority Leader John Boehner didn’t mince words. “The implementation of the Medicare plan has been horrendous,” he said.

Today, Medicare Part D has more than 50 million beneficiaries and is extremely popular. In an October survey, over 90 percent of enrollees described themselves as satisfied. “The temporary issues were just that, temporary,” said Mark McClellan, who led Medicare during the rollout. “The memories didn’t last that long. In the end, it comes down to how good the insurance coverage is.”

The administration contends its signature legislative accomplishment is on a similar trajectory. In fact, officials say, it’s already working better than expected. A recent study by Avalere Health found that the premium bids in the marketplaces were coming in below the Congressional Budget Office’s early estimates.

But Medicare Part D didn’t face the kind of sustained political opposition that Obamacare faces. In 2006, the Senate Special Committee on Aging held a hearing on the then-flailing program. Rather than calling for repeal, Sen. Herb Kohl of Wisconsin, then the top Democrat on the panel, said it was important “to put aside any partisan thoughts to work together to get this program running.”

Obamacare doesn’t have that luxury. McConnell has already promised to make it “the biggest issue” of the 2014 midterm elections. There is little chance the Obama administration will be able to tweak or change the legislation if problems emerge. Rather, if the law stumbles, Republicans will use its troubles to gain seats in Congress and chip away at its core provisions.

Even so, Democrats are feeling calmer as the administration clarifies its plans.

“I think the train is doing a little better,” Baucus said. “There’s been no crash. I don’t think it’s derailed. We’re still chugging along here.”

Of course, Baucus doesn’t have to worry about the political fallout: Shortly after his “train wreck” comments, the six-term senator announced his plans to retire in 2014.

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Where are America’s Uninsured Young People?

By Tom Allison

In just three months, the first state health insurance marketplaces created by the Affordable Care Act will open, and millions of uninsured Americans will have the opportunity to purchase more comprehensive, more affordable coverage, often with the help of new tax credits.

With the deadline for enrollment looming, Young Invincibles is dedicated to making sure young people know their options and understand how to get covered.

Nationally, over 19 million 18 to 34 year olds are uninsured. Young people lack coverage more than any other age group group, making up 42% of the estimated 45 million uninsured nationwide.

That’s why we’re launching the Healthy Young America Campaign. We’ve done extensive research on insurance rates in every state of the nation and put together fact sheets for advocates to get the word out and make sure young people sign up for health insurance. We have a growing list of frequently asked questions and developed an app to help young people find coverage and health services.

To bring together all of our research, we created this interactive map of insurance rates among 18-34 year olds. How do the states stack up? Massachusetts has the lowest rate (not surprising considering they passed a health reform law years ago).

But for those looking to enroll as many people as possible, showing the raw numbers of uninsured youth is useful as well. California leads the nation with over 2.8 million uninsured young people.

Whether you’re a local non-profit looking to enroll young people your state, a state looking for outreach methods to reach their youth population, or a young person looking for information on your options, we want Healthy Young America to be a resource for you.

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It’s Hard Being Iron Man: Young Adults & Their Quest to be Mental Health Superheroes

In the recent blockbuster movie Iron Man 3, Robert Downey Jr. plays Tony Stark (aka Iron Man), a self-described “Genius Billionaire Playboy Philanthropist” who fights bad guys with the help of his flying suit of armor. Tony Stark comes off as cocky to everyone he meets, but beneath his brash exterior he conceals a lot of issues. Superhero-ing isn’t exactly a low-stress occupation, and in the new movie Tony starts to have panic attacks when it all gets to be too much for him.  Yeah, it’s tough to be Iron Man.


While I was watching the movie, it struck me that Iron Man’s plight isn’t too different from the average young adult today. Though Millennials may sometimes seem invincible in reality they’re just as vulnerable as everyone else when it comes to their mental health, if not more so.

Time Magazine recently dubbed young adults “The Most Stressed-Out Generation,” and a survey by Harris Interactive recently showed young adults between the ages 18 to 33 report higher levels of stress than any other age group. It’s not just stress… researchers have found that young adults are at the center of a “perfect storm” of mental health risks.  Without the necessary care, young adults are unfortunately are at a higher risk of engaging in destructive behaviors such as substance abuse and suicide.

Here are some other facts you may not know about young adults and mental health:

  • One in five young adults (18-25) experienced mental disorders in the last year
  • Suicide is the number three cause of death among young adults.
  • Young adults (18-25) binge drink, smoke, and use drugs more than groups both younger and older than them.

Without getting the care they need, Millennials would have a tough time getting even close to superhero status anytime soon.


But wait, what’s that up in the sky, bringing hope to young adults everywhere? No it’s not Iron Man, it’s the Affordable Care Act!

There are several new rules in the new law that should help improve mental health care for Millennials, including:

  • Starting next year, insurance companies won’t be able to deny coverage to people with pre-existing mental health conditions
  • Plans must cover 100% of the cost of important mental health services such as depression and substance abuse screenings
  • All health plans must cover mental health and substance abuse services
  • All health plans must pay for the same percentage of mental health services that they do for physical health services. This means that if an insurance plan pays for 80% of a visit to your doctor, it has to pay for 80 % of a visit to a psychiatrist too

Studies have shown that these changes are already starting to help Millennials get the care they need. Last year, more young people were seeking emergency mental health care and less young people were putting off needed mental health care. As more changes in the new health care law come into effect, more and more young people will be able to access the mental health services they need.

Maybe, just maybe, if young people can get the care that they need, they can save the day in the real America the same way Iron Man does in the movies.  They might even look just as awesome doing it.



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Update from the Golden State

By Ariel Boone

Since our last update, Young Invincibles has been realizing its dreams of westward expansion. California’s team has grown to a staff of eight, now including the California Policy and Research Director, Linda Leu, and me.  Three weeks ago, I started as the California Policy and Organizing Manager, joining the all-star team who opened the sunny Los Angeles office.

 Los Angeles Office

In May, Organizing and Communications Fellow Ben got the pleasure of turning the keys on our new digs.

ben keys

Some people wait a lifetime for a moment like this.

Health Fairs

Alongside our faith in social media, Young Invincibles knows that taking root in our CA communities sometimes means putting our boots on the ground where people seek advice.  We’ve offered resources and reached community members at WeConnect health fairs in Riverside, Sacramento, Bakersfield, and soon, San Diego.  Below, CA Communications Coordinator Adriana, CA Outreach Coordinator Aurora, and Ben at a health fair in May.

bakersfield fair

This booth was made for talking…

Netroots Nation

The third week of June, Adriana, Maria, and I drove to San Jose, CA for Netroots Nation 2013.  My inner nerd had dreamed of attending for years – it’s an annual conference about organizations and individuals using data and digital tools in smart ways.  It was like a high school reunion of every campaign I’ve ever worked on, every issue I’ve ever cared about, and every organization whose petition I’ve ever signed.

ariel nn

We were the cool kids table in the proverbial cafeteria.

maria nn

CA Outreach Coordinator Maria handled the Wheel…of…Millenial Misfortune!

Focus Groups

Young Invincibles continues to test our mobile app with communities across the Los Angeles area – young adults deserve an easy-to-use tool to get care and medical services, and give the best feedback on their wish list.  Every focus group raises thoughtful questions about the barriers young adults currently face in seeking care, which we then tailor to our presentations and training of other organizations.

maria focus

Maria’s group in June at the St. John’s Medical Center, in South LA, is definitely focused.

Community Events

Power 106 paired with Young Invincibles and Care1st to educate Californians about their health care options with the new marketplace opening October 1st. The response was overwhelming.

power 106

We were more popular than ice cream on a sunny day.

Student Loans

On June 10, 2013, Young Invincibles participated in a press conference hosted by Congress members Judy Chu (CA-27) and Adam Schiff (CA-28). California Director Tamika Butler spoke alongside student leaders and community college Presidents at the event, urging Congress to act before July 1st to keep federal student loan rates from doubling from 3.4% to 6.8%. We’re still working on keeping to keep student loan debt down and we are not going anywhere.


Friends, Romans, countrymen, lend me your ears… and cap my borrowing rate to ensure my repayment won’t stop me from having a family, making a life, and finding a good job!

Yay Area

After the opening of our Bay Area office in August, Northern California denizens will hear more voices and strong opinions from Young Invincibles in health care, higher education, and jobs conversations in the upper half of the state.  We are eager to get started, and can’t wait to be closer not only to decision makers in Sacramento, but also to vulnerable communities in NorCal.  Linda and I are both Bay Area locals, and if you are, too, we hope to work with you soon!

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