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Mar 31, 2014 | The Episcopal Health Foundation

EHF Report Shows Texas’ “Young Invincibles” Have Little Knowledge, Low Opinion of Affordable Care Act

HOUSTON – (March 31, 2014) – As the first open enrollment period in the Affordable Care Act’s Health Insurance Marketplace comes to a close, much attention is focused on whether the so-called “Young Invincibles”—adults below age 35—will enroll in Marketplace health plans. “Young Invincibles,” is a term coined by the health insurance industry to describe young adults who forego health insurance believing that they are too healthy to justify the cost of coverage.


More than one-third of Texas’ six million uninsured residents is a “Young Invincible” and their participation in the Marketplace is critical to reduce the uninsured rate among all Texans. While these young adults have substantial need for health coverage, on the eve of the launch of the Marketplace, Texas’ “Young Invincibles” had a poor understanding of the Affordable Care Act’s health coverage opportunities and held a low opinion of the new law, according to a report released today by the Episcopal Health Foundation and Rice University's Baker Institute.


"The Affordable Care Act is the most ambitious and most expensive federal health care program since the creation of Medicare in 1965," said Elena Marks, president and CEO of the Episcopal Health Foundation and a health policy scholar at the Baker Institute. "Given its cost, it is imperative that we track its effects on both uninsured and insured Texans. The enrollment of young adults in Marketplace plans is important to the long term success of the ACA,” Marks added.    


The report released today is part of the Health Reform Monitoring Survey (HRMS)-Texas, based on the HRMS, a national project that provides timely information on implementation issues under the Affordable Care Act (ACA) and changes in health insurance coverage and related health outcomes. The Episcopal Health Foundation and the Baker Institute are partnering to fund and report on key factors about Texans obtained from an expanded representative sample of 1,595 Texas residents.


Marks co-authored the study with Vivian Ho, a professor of economics at Rice and a professor of medicine at Baylor College of Medicine and the chair in health economics at Rice’s Baker Institute, and Patricia Gail Bray, director of the Episcopal Health Foundation's research program and an adjunct faculty member at the University of Texas School of Public Health's Fleming Center for Healthcare Management.


"The survey results indicate that while there are millions of young adults who could benefit from the Marketplace plans, as the Marketplace opened, they were poorly educated about their opportunities." Ho said. "Their unfavorable opinion of the ACA makes the educational efforts that much more difficult.”


Details from the Report

Today’s HRMS-Texas report is the second in a series on the implementation of the Affordable Care Act in the state and examines the experiences of Texas’ “Young Invincibles” in obtaining and paying for health care services and their knowledge and opinion of the ACA.


The HRMS-Texas data show that, despite the potential benefits for young Texans, at the opening of the Health Insurance Marketplace in October 2013, they knew very little about the available opportunities. Forty-three percent reported having a somewhat to very unfavorable opinion of the ACA, while only 24.3 percent reported having a favorable or somewhat favorable opinion.


When asked about their knowledge of how the ACA would most significantly impact them, “Young Invincibles” indicated they knew little or nothing at all. More than 70 percent reported that they had heard only a little or nothing at all about the Marketplace and more than half had not heard that children up to age 26 could remain on their parents’ health plans.


Young adults in Texas are more likely to be uninsured than older adults: 28.3 percent of “Young Invincibles” compared the 21 percent of their older counterparts. While 56.9 percent of older adults are covered by employer sponsored health plans, only 47.2 percent of young adults had such coverage. Not surprisingly, the HRMS-Texas data show that prior to the opening of the Health Insurance Marketplace, Texas’ young adults struggled to pay medical bills and were much less likely than older adults to have a usual place to go for health care. Young adults with household incomes between 139 percent and 400 percent of the federal poverty level—the income group for whom the Marketplace offers substantial premium and cost-sharing subsidies—reported the greatest trouble paying medical bills among all young adults.


The ACA aims to increase the number of young adults with health insurance coverage by allowing those under age 26 to stay on their parents health plans and by offering the lowest Marketplace plans to those under age 30. The HRMS-Texas data show that young adults would benefit from health coverage by improving their ability to pay for care and establish a relationship with a provider.


The HRMS was developed by the Urban Institute, conducted by survey company GfK and jointly funded by the Robert Wood Johnson Foundation, the Ford Foundation and the Urban Institute.


For more information or to schedule an interview with Ho or Marks, contact Carol Barnwell at or call 713.353.2140.



Related materials:


Ho bio:

Marks bio: