The biggest threat to the success of the Affordable Care Act may not be Sen. Ted Cruz (R-Texas) and his drive to defund the program in Congress. It may be the friends of Christine Ortiz-Gonzalez, a 24 year old community college student in San Antonio.
"Most people I know don't have much money, and they're buying things they want rather than things they need," she said Monday. "If they have a little extra money, they're going to buy an iPad and not health insurance."
Several top Obama Administration officials, including Labor Secretary Thomas Perez, met with students here today in the first in a series of college rallies across the country to attempt to convince healthy young people, known as 'the young invincibles,' to buy health insurance which many of them feel they don't need and can't afford.
"The value that this President is all about is the value of community," Perez told a roomful of students at San Antonio College. "We're all in this together."
The drive to make sure young people buy health insurance is critical to the success of the entire program, according to Chris Jacobs, a health care policy expert at the Heritage Foundation, a conservative think tank.
"Obamacare relies on an influx of young, healthy individuals choosing to buy health insurance coverage, to offset the high health costs of older, sicker individuals," Jacobs said. "But at a time when unemployment among college-age students is 13 percent, and millions more young people are under employed and struggling to pay bills, its a stretch to assume 20 somethings will be able to afford $150 to $200 per month for health insurance."
In addition to the patriotic pitch, Perez touted the advantages of having health insurance, and the low costs younger people can expect to pay thanks to subsidies and tax benefits included in the bill.
"The amount of money that it costs to enroll is less than the monthly cost of an iPhone or other device," he said.
He said "6 in 10" young people who are eligible for coverage under the insurance exchanges, which are set to open next week, will be able to obtain coverage for less than $100 per month. Perez also touted the fact that young people can also remain on a parents’ health insurance plan until age 26.
According to figures released last week by the Census Bureau, Texas has the highest percentage of residents without health insurance in the United States, 24.6%, or 5.3 million people. Perez said students at the college level are 'disproportionately uninsured.'
Devon Herrick, a senior fellow at the National Center for Policy Analysis, says that is because, like Christine Ortiz-Gonzalez' friends, health insurance is a 'low priority' for young people.
"All told, about 19 million 18 to 34 year old are uninsured, most are healthy and know they can pay incidental medical bills out of pocket," Herrick said. "Young adults' reluctance to purchase health insurance is especially interesting in light of the fact that Affordable Care Act proponents hope that young adult enrollees will make health coverage 'affordable' for older, sicker, middle-aged enrollees."
U.S. Rep Lloyd Doggett (D-Texas) says the goal of the college meetings is to show young people that ‘they have a significant amount to gain from participating in this opportunity.’
“Since they tend to have lower incomes they will qualify for significant tax credits to purchase health insurance,” he said.
Convincing young people to buy health insurance "is going to be an uphill battle, absolutely," said John Davidson, a health care policy analyst at the Texas Public Policy Foundation, a conservative organization. He says in almost all cases, the penalty a college student would pay for not buying insurance will be less than the amount they will be charged for coverage under the exchanges.
"It is a question of what people are more likely to do," he said. "If young healthy people choose not to sign up, it is going to trigger what we call an adverse selection spiral, in which the risk pool doesn't have enough healthy people in it so premiums go up, and eventually the market collapses."
He said rules in the act which prevent older people from paying any more than three times what young people pay for insurance to artificially boost costs for 'young invincibles' to about twice what a young healthy person can obtain insurance coverage for today.
Perez said it is important for 'young invincibles' to look at the bigger picture.
"The healthy people need to know that they are only one accident away from being very unhealthy," he said.
If student Andrew Hubbard is any indication, Perez' message hit home for many of the young people in attendance at today's rally.
"I think young people realize that we need health care coverage throughout our lives," he said. "Not just when you're old, but when you are young too."