(HealthDay News) — Enrollment of young adults is a crucial component of the viability of the Affordable Care Act (ACA), according to a health policy brief published Dec. 16 in Health Affairs.

T.R. Goldman, a journalist based in Washington, D.C., in collaboration with Health Affairs and the Robert Wood Johnson Foundation, examined what the law says about enrollment, what the key issues are in determining if young Americans will enroll, and what is next in the rollout of the ACA.

While the ACA offers several mechanisms to extend health coverage to more Americans, including extended dependent coverage, expanded Medicaid, new health insurance Marketplaces, and premium subsidies, these tools are not being implemented as planned. The Supreme Court’s ruling made Medicaid expansion optional and, as of November, only half of the states and Washington, D.C., have plans to expand Medicaid. The initial rollout of the marketplaces has been plagued with technical problems. The problem is that even with tax incentives, confusion and reluctance on the part of young adults remain significant obstacles to enrolling sufficient numbers of young adults.

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“Even with 100 percent awareness, however, the biggest problem for low-income young adult coverage is the lack of Medicaid expansion in every state,” the authors write.

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