The image projected before the classroom of Cal State L.A. students showed a pair of gleeful sky divers plunging through the air.
"You're young and you're healthy.... Why do you need health insurance?" a caption asked.
The answer to that question — posed in the presentation by recent graduate Carla Bracamonte, part of a cadre of new, state-funded medical insurance educators working on California campuses — is vital to efforts to overhaul the nation's healthcare system.
Supporters and detractors of Obamacare are fixating on so-called "young invincibles" like the Cal State students, generally healthy adults in their 20s and 30s who don't rack up large healthcare bills.
Only by collecting premiums from many more of those infrequent users of medical services can insurance plans expect to offset the higher costs of treating newly insured older and sicker patients. An oft-repeated estimate is that for the White House's reforms to succeed, 40% of those signing up for coverage through new state and federal healthcare marketplaces must come from the under-35 adult demographic.
But with critics of the healthcare changes producing ads urging millennials not to sign up, it's unclear whether that prized group will respond to outreach efforts of supporters like Bracamonte. National figures showing how many in that cohort are enrolling haven't been released. In California, a bellwether state, about 22% of those who enrolled in coverage over the first two months came from the under-35 target audience.
In addition to displaying the sky-diving duo, Bracamonte's Power Point presentation last month focused on care that young adults might find themselves needing: asthma treatments, reproductive services and mental health counseling.
The campus health center won't be able to help if students are injured in a late-night car accident, she reminded the audience. And a three-day hospital stay can run $30,000, she added.
The two dozen students listened politely. Some took notes or flipped through brochures Bracamonte provided. A few seemed bored.
The energy picked up when Bracamonte took questions.
"Even if you don't go to the doctor, do you still pay?" one man wanted to know.
More concerns tumbled out. What if your parents are undocumented? What if your income changes? What makes so many people say this is so horrible?
The probing continued nearly as long as Bracamonte's 30-minute slide show.
Honing an effective message for young adult consumers has been a struggle.
"This is a very good deal for our students," said Walter Zelman, a public health professor who is coordinating outreach teams on 15 Cal State campuses. "We just have to reach them. It's difficult to get students to focus on something that's reasonably complicated and not something they're craving."
Bracamonte said: "We're looking for that tipping point" — the moment when distracted, busy students start weighing their healthcare choices.
Interest in the insurance marketplaces is strong among young people, according to some polls. But nearly 60% of 18-to-29-year-olds without insurance disapprove of the healthcare changes, according to a report released last week by Harvard University's Institute of Politics. Fewer than a third said they were likely to enroll through the new exchanges, and 41% said the chances of that were "50-50."
As part of a push to reach college students funded by a $1.25-million grant from Covered California, the state's health insurance exchange for the public, trained educators from Cal State's Health Insurance Education Project are becoming regulars in student centers and classrooms, seeking to demystify and pique interest in new healthcare options.
Cal State campuses are a prime venue to woo younger insurance customers. Many of the system's students — disproportionately Latino, modest-to-lower-income and under-insured — stand to benefit from the healthcare changes, Zelman said. He rejects the "invincibility" notion: that young people don't buy insurance because they doubt they will need it. He points to surveys suggesting millennials don't buy insurance because they can't afford it.
Up to 75% of Cal State students have incomes that would qualify them either for federal subsidies to help pay insurance premiums or for California's Medi-Cal program, which will offer care for childless adults earning less than $16,000 annually starting Jan. 1. At Cal State L.A., a 2011 student survey supervised by Zelman's department found that 41% of students polled were uninsured and nearly a third of families of incoming freshmen earned less than $20,000 a year.
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