‘New York State needs plans in place to make sure New Yorkers never have to fear that they can’t get health insurance. For example, the state needs to expand access to affordable coverage for New Yorkers who don’t have health insurance and can’t take advantage of New York’s policy to remain on their parents’ plan until they’re 29.’

As the Supreme Court considers the constitutionality of the Affordable Care Act (ACA) following a GOP challenge to parts of the law, I am reminded of people like Mia, a client of our organization, who on her 26th birthday next month may find herself uninsured for the first time in her life. During the pandemic, Mia was laid off, stripping her of her income and health coverage in one fell swoop. Luckily, her parents were able to support her with a place to live and add her onto their health plan thanks to the ACA, but with her birthday rapidly approaching, she is concerned about losing health insurance yet again.

Mia’s situation is unfortunately not unique among young adults in their 20s and early 30s, and it’s even more dire for those who don’t have a support system to fall back on. Young adults have been devastated by the health and economic impacts of the COVID-19 pandemic, but many lack the resources they need to get back on their feet or are unsure of where to turn for help. For many, it’s a challenge just to access the basics they need to stay healthy, like food and a place to live. This puts their health in jeopardy and threatens to increase city and state health care spending now and in the future.

Young adults are one of the hardest-hit communities in New York City when it comes to job and health insurance loss. Our recent survey investigating the health and financial situation of New Yorkers found that just a quarter (26 percent) of 18-35 year olds said their job is secure for the foreseeable future, compared with 63 percent of respondents aged 55 years old and over. Of 18-35 year olds, 15 percent have lost their health insurance since the start of the pandemic, compared to 10 percent of all survey respondents. Another 13 percent of 18-35 year olds didn’t have insurance to begin with and still don’t—this rises to 29 percent among Black 18-35 year olds.

Studies show that when people don’t have health insurance, they are less likely to go to the doctor for regular check-ups and other types of care. This matters both in the short- and long-term.

In the midst of a life-threatening pandemic, 8 percent of Black and 5 percent of all 18-35 year-old respondents delayed or decided against seeking care for COVID-19 because they couldn’t afford it. A whopping 40 percent of 18-35 year olds cancelled without rescheduling a regular physical or check-up since the pandemic began in March.

Delays and cancellations in care will lead young adult New Yorkers to get sicker sooner. For some, mismanaging conditions such as diabetes will cause long-term complications, while others could wind up in the hospital after ignoring their worsening COVID-19 symptoms. Long gone are the days when we thought COVID-19 didn’t make younger people really sick, and now, cold weather and more indoor gatherings in cramped apartments threaten the city with another spike.

This is bad for the health of an entire generation of adults, and it’s bad for city and state budgets. Preventive care and regular care for chronic conditions have been proven to save dollars for patients, payers, providers, and governments alike. Meaningful investments today will foster health care cost-reduction for the long-term—and it begins with protecting and expanding access to health care. 

The ACA can be an important tool to improve health insurance access for young people. It has cut the proportion of uninsured New Yorkers in half and provided billions of dollars in federal funding for free and reduced-cost health coverage. Regardless of what happens with the Supreme Court now or in the future, New York State needs plans in place to make sure New Yorkers never have to fear that they can’t get health insurance. For example, the state needs to expand access to affordable coverage for New Yorkers who don’t have health insurance and can’t take advantage of New York’s policy to remain on their parents’ plan until they’re 29. More health insurance losses among New Yorkers is simply not an option.

New York also needs to invest in meaningful job resources and opportunities and increase funding for community-based organizations to provide social support for working-age New Yorkers. Heading into the 2008 financial crisis, Generation X was roughly the same age as Millennials today, but had on average twice the total assets that Millennials currently have. Young adults today have fewer resources to fall back on than previous generations, and the situation is even worse for people of color, who are even more likely to lack the generational wealth of their white peers. This makes regular work and a steady income that much more important – without it, New Yorkers can’t afford the resources they need to stay healthy.

To prevent younger adult New Yorkers from getting sick sooner – either from COVID-19 and other current threats or mismanaged chronic conditions – the City and State government need to step up. Not only is it the right thing to do, but it will also create much-needed cost-savings in the future.

Lisa David is the president and CEO of Public Health Solutions (PHS).