Health Care Proposals Would Take Major Toll on Young, Low-Income Workers
by Pamela Chan & Jeremie Greer
As Republicans in Congress continue to debate a replacement to the Affordable Care Act, they should consider the impact proposed changes will have on young workers.
Harper grew up in a small town, but wanted to “get out and see someplace a little bigger.” This ambition took Harper to Portland, Ore., close to a few family members. The 21-year-old, who identifies as gender neutral, started working at a pizza restaurant and now trains new employees.
Harper enjoys working at the pizza shop, which offers good health insurance and a wage that’s enough to pay bills and rent on time. But Harper has chronic tonsillitis that’s getting worse and will eventually require surgery. Even with insurance, out-of-pocket expenses for the operation will come to $3,000. Harper is trying to save a little now and hopes an extra job will help cover the added expenses. Health insurance is the make-or-break factor that allows Harper to get by, rather than falling into a spiral of debt.
As Republicans in Congress continue to debate a replacement to the Affordable Care Act (ACA), they should consider the impact proposed changes will have on young workers like Harper. For those who don’t qualify for Medicaid or have access to a parent’s health care plan, health care costs can erect a barrier to financial security and upward mobility. A health care plan at work is essential. Even though medical bills associated with chronic illness can still be a source of stress, these costs are significantly lower than they would be in the absence of an employer-sponsored plan.
Under the ACA, the role of the employer is made explicit through a mandate requiring businesses with 50 or more employees to provide health insurance coverage. However, Senate and House proposals to replace the ACA would significantly weaken the mandate by ending or dramatically reducing fines for employers who don’t comply. This change would likely result in fewer businesses offering coverage and less workers with access to employer-sponsored health insurance.

As health and financial benefits have shifted from employers to employees over the last half-century, many young workers have found it difficult to access critical services, such as health insurance, 401(k) retirement accounts, and various forms of life and supplemental disability insurance. In 2016, Prosperity Now sought to get a better understanding of the struggles young workers face in the labor market. Our report, Beyond the Next Paycheck, highlights the stories of young people across the country who are doing their best to make it in a highly volatile job market. We met many young workers who are learning how to be good employees, manage their money and build a life of their own. But for many, health care costs are a major cause of financial stress.
In Harper’s case, health insurance is so important that they turned down an appealing job because it didn’t offer coverage. In considering the offer, Harper thought about pursuing other insurance options, but didn’t feel confident navigating the complex health care system, let alone affording the additional out-of-pocket expenses.

Harper isn’t alone. Many of the young workers we talked to depend on their employers’ health care plans, while those without such plans often choose to forgo coverage all together. The healthy ones are lucky. But those who aren’t healthy grapple with both health challenges and mounds of medical debt that can potentially spell financial ruin for years to come.

They are young workers like the 27-year-old, part-time sales representative who says she doesn’t have the money to afford insurance on her own. “I don’t have [health care], and I haven’t been to the doctor in a very long time. I haven’t been to check my eyes. I haven’t even been to the dentist, and my tooth really hurts…It’s been years since I’ve gone to the doctor — years.”
As the debate over health care continues in Congress, policymakers should remember the struggles facing these young workers. For them, health insurance doesn’t just promote physical well-being — it’s a critical component of their long-term financial health.
Pamela Chan is Project Director for Human Insights and Jeremie Greer is Vice President for Policy & Research at Prosperity Now (formerly CFED), a nonprofit working to put everyone in the US on a clear path to financial stability and prosperity.

