The perils of turning 26: when US millennials lose their parents’ healthcare


The Affordable Care Act extended coverage to millions of young adults, but many are reaching the cutoff point and risk falling through the gaps

Chanel White is dreading her 26th birthday. It is not ageing itself that shes worried about; what she fears is losing her parents health insurance.

White, 24, is one of several million young people in the US who were able to be put on their parents insurance scheme after Barack Obamas 2010 Affordable Care Act (ACA) was introduced, extending the age at which people aged out of a parental scheme from 18 to 25.

For White, such coverage was crucial. Months before her wedding in 2011, and at the age of just 19, she realised she was very sick. Her hands had been swelling and turning purple, her joints hurt and she was losing her hair.

She was soon diagnosed with thedebilitating and potentially life-threateningautoimmune disease systemic scleroderma. She had to undergo an invasive procedure to open up her blood vessels and had a finger amputated. There were countless appointments with doctors and specialists to help figure out how to treat the complex disease as it developed. At the time of diagnosis, she was not covered by her parents scheme and so received all this treatment without health insurance.

By the time we were married, two months later, we were over $100,000 in medical debt because we did not have insurance, said White.

The hospital ended up putting White on charity care, which reduced her debt to $12,000 more than a years rent in the couples first apartment, which they never moved into because they had to pay off medical bills.

As millennials occupy the insecure space between study and university, or are starting out in employment, they are unlikely to have health insurance, so many fall through the gaps and get saddled with enormous debt at a young age.

The ACA provision was an attempt to address that. It allowed White to get health insurance four or five months after her diagnosis, once her parents had found new jobs that would give them, and therefore her, quality coverage.

The ACA provision has had remarkable effects on young people in the US since it was introduced in September 2010, with 3 million young adults gaining insurance coverage in the 14 months after it was enacted.

Previously, unless they had student healthcare coverage or it was provided through their job, they were often uninsured, said Peter McGough, a University of Wisconsin professor of family medicine.

Unlike other high-income countries, including Canada, the UK and Japan, the US does not have a publicly financed universal healthcare system, despite the fact that taxpayer money funds roughly 64% of healthcare spending in the US.

Young people are generally healthier and are therefore less inclined to use their often small incomes to pay for health insurance. I was young, I was like I dont need health insurance. I never got sick growing up and bam, incurable fatal illness, White said.

Though she is nowinsured, she spends at least $600 per month on medical treatment not covered by her plan. And she is deeply worried about what will happen on her 26th birthday.

While I still have insurance through my parents, I tell my doctors all the time: I have a year and a half you guys need to do anything and everything while we have this because once I have the other coverage theres no guarantee I can see you guys any more, White said.

She plans to use a state insurance plan when she turns 26, which means she will probably no longer have access to the clinicians who have been directing her care.

Ive had friends that have had [that] happen, White said. They were told they can no longer see their doctor and they are going so downhill. Thats terrifying. I dont want that to happen to me.

McGough said that when the ACA coverage provision was enacted, a quarter of the young patients he saw for the first time were there for untreated mental health issues. Such problems peak in young adulthood, right when young people had previously been cut off from their parents plans.

Every aspect of the US mental healthcare system is overwhelmed by demand; reimbursements for mental health services tend to be low, which has driven many clinicians to stop accepting insurance altogether. And young people may be reluctant to seek care while covered by their parents insurance because of the stigma surrounding mental health disorders.

Yetti Ajayi-Obe was unhappy with the list of therapists provided by her insurer. Photograph: Courtesy of Yetti Ajayi-Obe

Yetti Ajayi-Obe, 27, first sought the care of a therapist in high school to treat depression. She had coverage through her familys health insurance plan, though her parents were not convinced that therapy was the answer. They finally agreed to let her see a therapist because she was cutting herself and their preferred therapies of herbal medicine or speaking to a pastor were no longer an option.

I come from a very strict African background so mental health and anxiety and depression arent things they want to take seriously or want to hear that their child has; they believe its more of a western thing, she said.

Ajayi-Obe stopped seeing a therapist in college, but wanted to start again after being overwhelmed by fear when she moved to New York City for work in 2012. She was intensely afraid of being alone and of travelling by herself.

Unhappy with the list of therapists offered by her insurer, she settled on one who did not accept her healthcare plan, and so had to pay out of her own pocket.

Matthew Conover currently has no insurance. Photograph: Courtesy of Matthew Conover

When Matthew Conover celebrated his 26th birthday in mid-January, he lost his health insurance. That same day, his 21-year-old brother went to the emergency room.

It just made me realise, if I get into a car accident later this afternoon and I have to go to the ER, I dont know how the hell I would pay for it, the bartender said. Its definitely a little bit scary and motivates me to get on to insurance.

Conover, who was covered by his parents insurance when he went to hospital as a child because of concussion and asthma flare-ups,can afford health insurance through his job and plans to get a state-sponsored plan in Virginia, but in the interim he is worried about the unexpected.

He is also frustrated by a system where people need to pay for their own care: I have a lot of friends who cant afford it or just dont have the financial stability to commit to a plan and thats very upsetting.

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