Making sense of health care reform over the past two years has not been easy. We spend more on healthcare than any other country and yet our life expectancy lags behind Chile, Cuba and the United Arab Emirates. Health insurers can deny coverage to a patient right when they need it most, in fact, because they need it most. Thankfully the Patient Protection and Affordable Healthcare Act was designed to make the system a little more user friendly. Pre-existing conditions won’t be a problem for anyone after 2014, and subsidized premiums (along with insurance exchanges) will allow millions of Americans to buy into private insurance plans for the first time. These reforms are badly needed and are a big step toward the rest of the industrialized world.

Young people are among the most uninsured demographics in America, with 49 percent of 19 to 24 year olds lacking coverage. Young people were also some of Barack Obama’s biggest supporters in the last election, preferring the Democrats by a record 38 percent. But how the new bill addresses this large group is not particularly consistent. One provision that has gotten a lot of attention is the extension of parental plan eligibility to 26, which is a big deal for many in the middle class. Unfortunately, this doesn’t mean the family rate will stay the same. Young adults will no longer be counted as children on the plan, but rather as adult individuals, meaning that premiums could be quite a bit higher. And because of the insurance mandate, young people couldnít simply opt out of health coverage and hedge their bets on good health. Paradoxically, this is partly because young people are so healthy and young people buying into coverage helps pay for others who need expensive treatment. So in a way, we’re expected to pay for our parents’ coverage.

But the bill offers some solutions. For a start, Medicaid will be expanded to everyone up to 133 percent of the poverty line (which is now around $11,000), and subsidies will be available up to 400 percent (mostly in the form of tax credits). And then there’s the much-advertised employer mandate provision: your boss has to offer health coverage if he or she employs more than 50 people, and there’s tax credits available for employers with less than 25 (covering up to 50 percent of employers’ costs). Young people will also be able to buy into “catastrophic” coverage with low premiums and high deductibles, basically paying for what you use. So if you’re generally healthy, your costs will be low, and if you get really sick, you’re covered. But if you’re not healthy, need expensive medications or can’t afford the out-of-pocket costs, catastrophic coverage won’t help much.

For those unlucky people, new high-risk insurance pools are in the works that will offer reduced rate coverage to anyone with a pre-existing condition who has gone without insurance for at least six months. Rates will hover around average premiums for healthy individuals, and the pools will be operated by the federal government, states or nonprofits. Currently 35 states operate such pools (including Minnesota, which has one of the most extensive), but with no rules on premium charges, the plans cost as much as twice the average individual rate. This is likely to change by June, in anticipation of the 2014 deadline, when private insurers will no longer be able to charge higher premiums because of pre-existing conditions. And while there are some doubts as to the financial viability of the program (most states run it at a loss and Washington is only promising about $5 billion), it has the potential to insure millions, including many young people.

OK, so there are some holes. The bill will by no means cover everyone. In Massachusetts, where similar reforms were implemented in 2006 (including a mandate and a relatively generous subsidy program), tens of thousands remain uninsured. Of course, things would be so much easier and more efficient if we could have a single-payer plan (of course, of course). But in the real world we have to put up with things like procedural filibusters, blue dogs and cornhusker kickbacks. Overall, the bill will help many people get coverage. Around 16 million will now be eligible for Medicaid and millions more for subsidies and other programs. For many young people, the bill could mean one less headache or one more trip to the doctor.

Tags: health