In health policy circles young healthy adults who don't buy health insurance are called young invincibles, the assumption being that they don't a put a priority on coverage. But a new report finds twentysomethings are more often priced out of insurance rather than opting out of coverage.
"Affordability is really the key reason why young adults don't enroll in health plans," said Sara Collins, co-author of the Commonwealth Fund report, "Covering Young Adults Under the Affordable Care Act: The Importance of Outreach and Medicaid Expansion."
Researchers found two-thirds of 19- to 29-year-olds they surveyed last spring said they had bought insurance offered through their jobs. Twenty-two percent said they hadn't because they couldn't afford it, while only 5 percent said it was because they didn't think they needed it.
"Young adults really do value health insurance," Collins said. "We see that in the large number of young adults who have stayed on their parents' policies in the last couple of years."
Fifteen million young adults have obtained coverage under the Obamacare provision allowing them stay on a parent's insurance plan until age 26.
And while so-called Obamacare remains controversial politically, the survey found it has not impacted enrollment choices among the young and their families. This year, 63 percent of those who identify themselves as Republicans say they are covered under their parents' insurance plans, up from 54 percent in 2011. That compares to 45 percent of self-described young Democrats, down from 50 percent in 2011.
"What it says is this has been a long-term problem for families regardless of their political affiliations," said Collins, "so being able to come onto a parent's policy really did benefit young adults."
Still, a big challenge for Obamacare proponents in 2014 is convincing young adults who cannot obtain coverage through their parents to buy insurance on their own.
Officials at Covered California, the Golden State's insurance marketplace authority, will be targeting so-called young invincibles for enrollment at schools, in the workplace and through advertising. But they don't think it will be a tough sell.
"We've been doing hundreds of focus groups," said Peter Lee, Covered California's executive director, "and while they may be young invincibles, they aren't young and stupid. They want to have insurance."
Beyond traditional advertising, both sides of the political divide on Obamacare plan to use social media to reach and engage young adults about Obamacare this fall.
The department of Health and Human Services launched a contest on YouTube this week aimed at young invincibles, with $30,000 in prizes for user-generated videos that highlight the benefits of signing up for coverage.
The Heritage Foundation is not offering cash, but it has launched a campaign of its own on Instagram, aimed at getting young people to post pictures of themselves with the sign bearing the hash tag #stopobamacare.
"We want to package the information in a way that the user or the reader is going to be able to digest it," said Ericka Andersen, who heads up the Heritage Foundation's social media effort to reach young adults. "We want to meet those people where they are."
The Heritage Foundation is also launching a $500,000 traditional media campaign to continue to press for overturning the Affordable Care Act.
Between the state exchanges, the federally-run marketplaces and political opposition ads, Kantar Media estimates political spending on the rollout of Obamacare could result in $500 million in advertising through 2014.
Insurers and health care providers could spend twice that according to Scott Roskowski, senior vice president of the media firm Television Bureau of Advertising, known as TVB. But they'll likely wait to see how strong enrollment proves, in the face of continued opposition to the law.
"If the sign ups happen in a major way," said Roskowski, "this health-care category, which has traditionally been a $600 million category across all mediums, now could suddenly be a billion dollar category."
The Obama administration is hoping to enroll more than 2.5 million young adults through the state and federal insurance exchanges this fall.
(Read more: Obamacare exchange readiness going down to the wire)
Commonwealth Fund's Collins says to get strong enrollment among young adults, the exchanges and insurers will need to spread awareness about subsides that will bring help bring premium costs down, as well as lower-cost catastrophic plans aimed at those under 30, who earn too much for premium assistance.
The bottom line, according to Collins: "Affordability is going to be key."
—By Bertha Coombs. Follow her on Twitter: @berthacoombs.
(CORRECTION: An earlier version of this story misstated the names of Peter Lee, of Covered California, and Scott Roskowski, of TVB.)