The fight over Affordable Care Act (ACA) subsidies is heating up again, and young adults may be the ones who pay the steepest price. With enhanced premium tax credits set to expire, millions of people could see their insurance costs shoot up. If you are between 19 and 34, experts say you are more likely to lose coverage than any other group.
This is not just politics in Washington. This is about your health, your wallet, and whether you will still be able to afford to go to the doctor if you get sick.
Why young adults are most at risk
According to an analysis from the Urban Institute, uninsurance rates among adults aged 19 to 34 would rise by 25 percent if subsidies expire. That is the biggest increase compared to any other age group. This is what is happening:
- Young adults often work jobs that do not provide health insurance.
- Many rely on ACA marketplace plans because employer coverage is not an option.
- Staying on a parent’s plan until 26 is only possible if parents actually have coverage to extend.
As Matthew Buettgens, a senior fellow at the Urban Institute, explained, “Young adults would see the greatest increase in uninsurance. These are people who are working and don’t have access to stable coverage through an employer.”
How many people could lose coverage
Estimates show between 3 million and 4 million people could lose insurance if Congress does not act. Young adults make up a large part of that number. Between 2009 and 2023, uninsurance rates for young adults dropped from 31 percent to just 13 percent. Without these subsidies, that progress could disappear overnight.
Children, on the other hand, are less likely to be hit as hard because programs like Medicaid and Children’s Health Insurance Program (CHIP) provide more safety nets.
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Who else will be affected by subsidy cuts
The cuts will not just hit young people. Other groups will also feel the squeeze:
- Racial groups: Black, non-Hispanic people are projected to see a 30 percent increase in uninsurance, while white, non-Hispanic people follow closely at 25 percent.
- Income levels:
- Households making less than 250% of the federal poverty level could see 23 percent lose coverage.
- Those earning between 250% and 400% would see the largest increase in uninsurance, at 26 percent.
- Even households making above 400% of the poverty line could lose access to premium tax credits, with about 200,000 projected to drop out of the system.
- Households making less than 250% of the federal poverty level could see 23 percent lose coverage.
What higher costs mean for hospitals and communities
This is not only about individuals. Hospitals are bracing for more uninsured patients. Jeff Wurzburg, a former attorney at the Department of Health and Human Services, explained, “Hospitals are already facing uncertainty regarding forthcoming cuts to Medicaid and stress on the Medicaid program. And so, this will just be another increase in the uninsured population, which means, ultimately, greater amounts of charity care and less patients with coverage.”
Hospitals in states that did not expand Medicaid are expected to feel the worst effects, since ACA subsidies have been filling that gap.
What could happen if subsidies expire
If subsidies expire, young adults could face some tough choices:
- Drop coverage completely, risking being uninsured.
- Search for cheaper, less regulated plans that may not cover real medical needs.
- Face financial risks from medical bills if an emergency happens.
Lorelei Salas, former supervision director at the Consumer Financial Protection Bureau, warned that ending affordable ACA plans could push people into “junk plans” that do more harm than good.
“Someone is going to come up with other products in terms of health insurance coverage that are going to possibly put people’s financial lives at risk, but there’s less oversight of those new markets right now,” she said.
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