Let’s be honest. You’d be hard pressed to even define “Obamacare”. You have no idea what a premium is. You know the Supreme Court made some healthcare decisions that President Obama was happy about, but you couldn’t say what they actually were. You’re a “young voter,” fitting squarely into the polling bracket of 18 to 24. You think healthcare issues are confusing and that they don’t really apply to you. You’re right about one of those things. This guide is here to clear up some confusion—because healthcare policy, especially this election season, directly impacts you.
This guide is intended for people under 26. Why? That’s when you get kicked off of your parent’s health insurance. That means that for those under the age of 26, the world is divided in two groups: those who have health insurance through their parents and those who don’t. The vast majority of people under 26 are insured through their parents. If you’re thirsty for knowledge, feel free to read the whole guide. If you have important Buzzfeed articles to send your friends, stick to the sections that apply to you. I also had to include a title, “What if I have a uterus?” because somehow that is still a relevant and debatable question.

This guide speaks about Republican and Democratic platforms generally, and can be applied to lower-ticket candidates as well as the presidential candidates.

If you get caught up on jargon, check out the glossary at the end!

I’m on my parents’ insurance

Congratulations! Your healthcare is somewhat more stable than your non-parent-insured counterparts. Go ahead and break that arm, it’s covered! However, just being insured does not mean you are well-insured or stably-insured, so there are a few things you’ll want to keep in mind when voting.

If you want to keep your parents’ insurance

Under the Affordable Care Act (ACA, Obamacare), your parents’ insurance must cover you until you are 26. As Naomi Rogers, Professor of the History of Science, Medicine and Public Health at Yale informed The Politic, “The 26-year-old part of the ACA is a direct and clear benefit to young people.” The Democratic platform in this election calls for upholding the ACA, including this particular aspect. The Republican platform calls for repealing the ACA. There is discordance between the presidential platform and the Congressional platform as to whether the age-26 law should stay. The proposal House Republicans introduced in June would keep the age-26 law. However, Trump’s plan includes allowing private insurance companies to decide how long you can use your parents’ insurance. In the past, this was typically to age 18 or 21. Since the new limit of 26 has been popular among the public, private insurers may keep it there. The thing about market solutions, though, is that you have to wait and see what the market does. If you anticipate needing to stay on your parents’ insurance because you will not have a job that guarantees benefits, you may want to support candidates that want to uphold the ACA or check in with your insurance company about what the age cutoff was before the ACA took effect. If the ACA is repealed, you might have to get your own insurance after you turn 21.

Another important thing to keep in mind is that the existence of public health insurance benefits those who use private insurance, as well as those on pubic plans. Even people who are on private insurance initially experience a benefit from public health insurance programs because, for them, those public programs serve as a safety net. Basically, you never know when your health costs will suddenly skyrocket or when your economic circumstances might change. You may want to vote for candidates in favor of public health insurance so that you can be covered in the event of any unwelcome developments in your private insurance.

If you lose your parents’ insurance

If the parent through which you get your insurance were to lose their job, they would lose their health benefits. As would you. As Rogers puts it, “Our system makes individuals much less empathetic to their peers who don’t have insurance. What do you do if your parents don’t have health insurance?”

As long as Obamacare is in place, you must have insurance. If you don’t have insurance because it is no longer provided by your parents, you would have to either a) sign up for your school’s insurance if you are a college student, b) sign up for Medicaid insurance if you qualify, c) purchase insurance (like an Obamacare plan or a private plan from a company like Cigna) through a marketplace, or d) pay the $695 fine for not having insurance. This sounds scary but there are a few very manageable options for you if your parents lose their jobs and Democrats stay in office.
If a Republican takes office there is a chance Obamacare will be repealed. Keep in mind that Howard Forman, Professor of Diagnostic Radiology, Economics, and Public Health, thinks repealing Obamacare after it has insured 20 million people is pretty unlikely. Under a Republican plan, you would not have to find other insurance. You would be free to just not have health insurance. However, it would also be more difficult to obtain insurance in this scenario, because the Obamacare plans and marketplaces would not exist. So, if you lose your parents’ insurance you’d be free to live without insurance, but God help you if you get hit by a car.

I’m not on my parents’ insurance

You are probably more literate about healthcare issues that your peers, because you have to be. As Rogers puts it, “You have to be thinking about costs and insurance all the time.”

Insurance

Under the Democratic platform, you will have to get insurance if you do not have insurance from your parents’ employer or from your college or job (Yale students are covered as undergraduates). Once you leave college (or if you don’t get coverage while you are in college from your school), you can either a) get your insurance through a job, b) purchase insurance through a private company like Cigna, c) get Medicaid insurance if you qualify (you probably do as long as your parents don’t write you as a dependent on their taxes), d) sign up for an Obamacare program, e) pay the $695 fine for not having insurance.

If you feel like you should not have to be legally mandated to have health insurance, you may want to vote for candidates that wish to repeal Obamacare. Remember, though, that Forman thinks this is pretty unlikely, since 20 million people have gained coverage due to the law’s passing. In addition, repealing will also make it more difficult to get insurance if you choose to do so, because Obamacare plans and marketplaces that make it easy to buy insurance would disappear. Be careful if you do not want to get insurance, though—accidents do happen.

Medicaid

Medicaid is a solid choice for health insurance for young folks who might not have the financial stability to get health insurance. Qualifying for Medicaid (health insurance for low income folks) is a state-to-state deal. So Texas residents and California residents are playing a different ballgame. In some states, everyone who falls below 138% (a little more than) the federal poverty line qualifies. In these states, it does not matter if you are single or married, unemployed or employed, a parent or not, you qualify if your family structure places you a little bit above the poverty line. In other states, you may need to have a child or have an income lower than 138% of the poverty line in order to qualify. If you anticipate that you may need to rely on a social safety net program for health insurance, you might favor a candidate that errs on the side of “expanding Medicaid” which means that candidate will push states to include more people in their Medicaid program.

A major issue in the past few years has been “Medicaid expansion”. But what even is that? Here is a long explanation. The short explanation is that conservative governors typically do not want to expand Medicaid even though it costs states nothing. Many conservative leaders feel that Medicaid is expensive charity for people who do not want to work. They would rather save the government money than offer subsidized healthcare to people that they feel could work for it.

CHIP

This is no longer an issue personally for those over 18, but it bears mentioning that Hillary Clinton wrote the Children’s Health Insurance Program (CHIP), which provides extensive, free health coverage to poor children. If you had CHIP as a child or ever faced unstable healthcare coverage, this may be important to you.

Things That Apply to Both

Preexisting conditions

If you have a pre-existing condition, you may want to pay attention to the major parties’ stances on healthcare. The ACA makes it illegal for insurance companies to deny coverage to people with pre-existing conditions. If the ACA stays in place, you’re good to go. If Republicans repeal Obamacare, there is a chance that insurance companies could charge extra or deny coverage to those with preexisting conditions. Republicans intend to “repeal and replace” Obamacare. The plan House Republicans have suggested to replace Obamacare protects those with pre-existing conditions from having their rates increased. However, in April 2016 Paul Ryan said in a speech that he would pull people with pre-existing conditions out of the general insurance market and create a special state fund to pay for their higher healthcare costs. That way, insurance would be cheaper for everyone else because risky “uninsurables” are no longer adding costs to the insurance company. However, Ryan’s words and the plan do not approach the issue the same way, and Trump’s plan doesn’t say anything about pre-existing conditions at all. So, there is reason to be uncertain about how Republicans, congressional or presidential, would protect this population.

Paying for Medications

Having insurance through your parents does not mean you pay reasonable co-pays for prescription medications. You may be concerned that your medications are already too expensive or that they may increase dramatically. The Republicans intend to take several measures to increase market competition between pharmaceutical companies, which according to economic theory, would drive down prices for people buying the medication. The Democrats want to take a more hands-on approach. They intend to remove tax loopholes that allow companies that create monopolies on certain drugs or market directly to people who consume the medications. However, this may drive companies to move overseas, which we already see happening. All in all, pharmaceutical companies get so many tax breaks, and spend so much money on R&D, that they would likely survive federal oversight of drug costs.

Premiums, Copays, Costs

You may be worried that even if you stay on your parents’ insurance, your premiums (the amount you pay each year up front for your insurance), copays, or other out-of-pocket costs might go up because of Obamacare or other policies. Honestly, there is evidence to support that this is happening and there is evidence to support that costs are not increasing. Anyone who says they are sure about this trend is oversimplifying the issue. If you have not experienced noticeable increases in the first 6 years of the ACA, you probably won’t.

Does Healthcare Reform Make it Harder for Me to Get A Job?

No. You might be worried, as a young adult, that the ACA has led to job decreases. This, however, is not true.

In fact, there’s a chance that people can explore alternative career paths more if they have access to insurance through something other than employment. If you plan to pursue graduate school, internships, travel, volunteer work, or other post-graduation paths that don’t guarantee insurance, you may benefit from options provided under Obamacare.

 

What if I have a uterus?

Good question! If you have a uterus, you may be wondering whether your access to reproductive healthcare is at stake in upcoming fall 2016 elections. It is.

The Supreme Court

If you are concerned about abortion access or whether or not your employer-based or otherwise private insurance will cover birth control, you should pay attention to the type of Supreme Court Justice that a candidate would appoint or vote to affirm.

Originally, the ACA mandated that private health insurance plans cover birth control such as the pill, ring, implant, or IUDs. However, in Burwell v. Hobby Lobby (2014), the Supreme Court decided that some companies could choose policies for their employees that do not cover birth control. In turn, the White House responded by changing the law to say that employers who do not want their employees to have coverage can apply for an exemption that would then allow those employees to get birth control using partial federal coverage. However, the Catholic Church is now challenging that legislation. So, the point to keep in mind is that for those with private insurance, coverage of birth control is very much on the table for debate. The Supreme Court is probably the stage upon which this issue will be fought out. If you need birth control to be covered by your insurance because it is too expensive otherwise, you may want to support candidates that will support Supreme Court appointees that will uphold access to birth control.

The Supreme Court will also likely make several impactful decisions about abortion rights in the coming years. Republicans promise to only appoint or affirm anti-abortion justices and Democrats promise to only appoint or affirm pro-abortion justices.

Planned Parenthood

Anyone who requires sexual or reproductive healthcare, especially those with uteri, may need to turn to Planned Parenthood for those services. Many people receive these services from physicians through their insurance. However, some may prefer to visit a Planned Parenthood for those services and some may not be able to pay copays for birth control or exams at private offices.

If there is a chance you will not be able to access sexual or reproductive healthcare, such as STI testing, abortion services, or obtaining birth control through private doctors, you may want to support candidates in favor of keeping Planned Parenthood running.

This is particularly salient in state-level elections. Democrats tend to support Planned Parenthood and Republicans tend to want to remove funds from Planned Parenthood in the hopes of shutting it down. Recall that Republicans intend to replace Planned Parenthood clinics with Crisis Pregnancy Centers and other small clinics that can provide sexual health services. This is a highly partisan issue, but there is significant evidence to show that those who require sexual and reproductive health services will have a harder time accessing care in places where Planned Parenthood cannot function.

The Hyde Amendment

Due to a law called the Hyde Amendment, no federal tax dollars may be used by any entity to provide abortion services. This may be particularly harmful to young, low-income people who can get pregnant. The Democratic platform calls for the Hyde Amendment to be repealed so that there is no disparity of access to abortion for low-income people with uteri. The Republican platform calls for maintaining the Hyde Amendment so that federal tax dollars cannot be used for a controversial medical procedure.

Presidential Candidates’ Positions

Hillary Clinton

Clinton’s plan, which is very much in line with the Democratic platform, looks for government solutions to gaps in healthcare access. Clinton’s plans are delineated on her website. Follow this link to read her healthcare plans in general. From that page, you can click on eight other pages that list more detailed plans on topics like managing prescription drug costs, building up healthcare infrastructure, and tackling the Zika virus. As Forman puts it, “Clinton wants to take an interventionist approach using the ACA as an anchor.” She intends to “strengthen, improve, and build upon” Obamacare. Under her presidency, it would continue to be illegal to refuse insurance policies to those with pre-existing conditions and public options would continue to be available to those purchasing insurance in markets. She would expand upon this by allowing non-citizens to purchase insurance as well as citizens. In addition, Clinton intends to work with governors to expand Medicaid so that more poor Americans can receive assistance. Clinton also plans to use tax incentives and penalties to de-incentivize pharmaceutical companies from suddenly hiking retail prices. Finally, Clinton plans to pass laws to ensure insurance companies must pay for general check-ups even without people meeting their deductibles. In Forman’s words, “Clinton wants to build on the ACA but knows there are still many issues to fix and many left uninsured by the ACA.” Basically, if you do not feel that capitalism can produce a high-quality, accessible healthcare system, Clinton is the choice for you.

Donald Trump

Trump’s plan relies on free market solutions to cover gaps in healthcare access. To read Donald Trump’s plan, follow this link. First and foremost, Trump plans to “repeal and replace” Obamacare. Repealing the law would have significant negative public health effects. These would ideally be mitigated by the plan Republicans would replace Obamacare with, but that plan has not been published. Forman is “frustrated” to hear Republican politicians speak about repealing, because it is so unlikely the ACA could ever be repealed. In addition to repealing Obamacare, Trump feels healthcare quality would improve if insurance markets, medical providers, and pharmaceutical companies operated according to free market principles free from government regulation. He argues that citizens should “consume healthcare” like other goods, which would lead to market competition, higher quality care, and lower costs for services and drugs. He also intends to allow competition from pharmaceutical companies overseas. Relatedly, Trump plans to allow states to determine Medicaid eligibility for their residents without federal oversight, despite the fact that Medicaid is federally funded. He also intends to allow people to open non-taxable Health Savings Accounts so that people can stow away money for medical expenses, which would make high-deductible insurance plans less risky. As Rogers explains, “Trump has a vision for national health insurance companies.” All in all, if you have faith that capitalism can produce a high-quality healthcare system without federal regulations that every American can access, you probably agree with the Republican policy.

Glossary of Terms

CHIP- The Children’s Health Insurance Program guarantees extensive, free health insurance to minors whose parents do not have insurance for any reason.

Copay- An out-of-pocket fee you pay for doctor visits or medications that insurance does not cover. For example, you might have a 20% copay for your asthma medications, so insurance would pay $80 and you would pay a $20 copay.

Deductible- The amount you pay for doctor visits and medications out of pocket before insurance pays a dime. If you have a $500 deductible, and pay $100 per month for a medication, you will pay for that medication out of pocket for 5 months before insurance kicks in to pay their percentage.

Health Savings Account- This is a Republican idea. HSA’s are savings accounts for people with high deductible insurance plans so that they can be sure they’ll have the money to pay for medical expenses if those expenses present themselves (like a car accident). You wouldn’t have to pay tax on money you put in these accounts.

Marketplace- This is basically a website you can go on to “shop” for insurance. You can buy private insurance (like UnitedHealth or Aetna), buy a public option (insurance from the federal government), or see if you qualify for Medicaid or CHIP (but you have to do a separate application to actually get those)

Medicaid- offers health insurance from the government for poor adults. States determine eligibility so if you’re a poor single person in California, you’re covered, but if you’re a poor single person in Virginia, you’re not.

Obamacare- The Affordable Care Act or ACA is a package of laws passed in 2010 that aims to get all Americans access to health insurance through insurance. Obamacare expands the public (government funded) programs originally laid down by Medicaid to include more people for less money. It includes the insurance mandate, contraception coverage mandate, and pre-existing conditions laws discussed above.

Premium- The sticker price you pay each year for your insurance

Public option- An insurance package you can buy that is run by the government. It’s like Medicaid, but you pay for it. This is for people who historically could not afford a private plan (Aetna, UnitedHealth) but weren’t poor enough for Medicaid.

A note from the author

This guide is intended to be politically neutral. Despite mine and my editors’ attempts to make it so, it may fall short of that aspiration. I am compelled to note that I utilized social safety net services my entire life. My siblings and I were on CHIP until I turned 18 and my mom did not have health insurance until 2014. I cannot isolate my writing from my experience of healthcare scarcity. I am often disheartened that politicians take away access in a cavalier manner. For comments and suggestions, please email Cassie Lignelli, at cassandra.lignelli@yale.edu.

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