[4] There are risks associated with the young invincibles choosing to operate outside of the health insurance market, stemming from the economic phenomenon of adverse selection.
As insurance premiums rise, more healthy people decide that it is not worth the higher prices, and drop out of the market, leading to what is called the "adverse selection death spiral.
[8] Prior to the ACA, most employer-based health insurance plans stopped dependent coverage when the child turned 18 or 19, or had graduated from college.
[6] Reasons for exemption vary, such as homelessness or experience of domestic violence, and some require documented proof, such as an eviction or foreclosure notice.
[4] Many studies reporting on this effort conclude that insurance may be too great an expense and provide too little benefit to healthy young adults, making them willing to pay the penalty instead.
As health care reform under the ACA is closely associated with the Obama Administration and the Democratic Party, some young Americans may base their support on political affiliation.
[11] Political groups opposed to reform have developed campaigns encouraging young adults to refrain from purchasing insurance in the Marketplaces.
Leading up to and throughout the first annual enrollment period, health insurance Marketplaces and advocacy groups released social media and other forms of campaigns.
[14] Maryland’s Maryland Health Connection partnered with 2013 Super Bowl champions, the Baltimore Ravens, to connect with residents on the importance of developing a “health coverage game plan.”[15] The American Association of Retired Persons (AARP) developed a series of e-cards for parents to send to their children as a reminder to sign up before the enrollment deadline.
Celebrities including pop icon Lady Gaga, singers Adam Levine and John Legend, and actresses Olivia Wilde and Amy Poehler, have shown public support for the ACA and Marketplace enrollment via Twitter and other social media outlets.
[18] Initial enrollment data from the Department of Health and Human Services show that young adults are signing up for plans in the Federally facilitated Exchange.
At the same time, the Commonwealth Fund’s Affordable Care Act Tracking Study revealed that 41% of visitors to Marketplaces were between the ages of 19 and 34, suggesting that overall enrollment numbers would continue to increase as the March 31, 2014 deadline approached.