Fifty-one percent of Millennials have a favorable view of the Affordable Care Act (ACA), also known as Obamacare; while 46% have a negative opinion. Accounting for partisanship and race, Democratic, independent, and non-white Millennials’ unfavorable views of the President correspond with unfavorable views of the ACA, and vice versa.
Millennials Pose Political Challenge for Ortho Leaders

According to a new Reason-Rupe survey released on July 10, 2014, the generation of 18-29 year olds known as Millennials, is a demographic sleeping giant with power to revolutionize the political landscape in the U.S. Their views on healthcare are worth knowing for leaders of surgical societies working to influence public opinion and public policy.
There’s good and bad news for notoriously Republican (GOP) leaning orthopedic surgeons. Millennials are fiscal conservatives but due to Republican conservative social positions, tune out the party.
The survey found that two-thirds of Millennials currently have health insurance and a third do not. Of Millennials who have insurance, a third obtained it through their employer, 19% have individually purchased plans, 39% are on their parents’ plan, and 5% have health insurance policies through their university or college.
Among the third that do not have health insurance, 54% said they would obtain it by the deadline this year, and 44% planned to pay the federal fine instead.
While Millennials are more supportive of the ACA than opposed, they do not support all of its components. Millennials are unwilling to pay more for health insurance in order to help provide coverage to the uninsured, 55% to 43%. Willingness to pay more to provide for the uninsured is dependent on whether the Millennial is currently paying for his own health insurance.
Millennials who pay for their health insurance oppose paying more to provide coverage to the uninsured, but Millennials who don’t pay for their insurance and instead are on their parents’ plan say they favor paying more.
In other words, according to the survey, Millennials’ support for redistributive health insurance reforms depends on whether they personally will be held responsible for the cost to provide for others. While they support the idea of providing for the uninsured, they are not willing to shoulder the cost.
Both those who purchase their insurance individually or through their employer and those who are on their parents’ plan support paying higher premiums if the benefit was universal rather than redistributive. Fifty-three percent favor paying more if it “resulted in expanded benefits for everyone, such as maternity care and mental health care, ” while 44% oppose paying more.
The survey concluded that the clearest political trends among Millennials are their staunch social liberalism and relatively ambivalent fiscal views.
“As a group, Millennials vote Democratic en masse, but not necessarily out of support for the party as much as out of even greater dissatisfaction with a GOP platform seen increasingly as out of touch with their priorities. Though Millennials currently tend to support the general concept of government guaranteeing ‘positive’ rights such as education, health care, and income, many of their underlying attitudes indicate they may become a generation that is both socially liberal and more fiscally conservative over the coming decade.”
When it comes to healthcare, Millennials seem to be saying they favor universal coverage, but want individuals to pay for it. If Millennials begin influencing elections and elect leaders with those views, leaders at such specialty societies like the American Academy of Orthopaedic Surgeons and the North American Spine Society might have to reconsider their political contributions and lobbying strategies that have favored and targeted Republicans.
To read the entire 100+ plus survey, click here.

Discussion
This is a fascinating development. In my practice we've seen similar outcomes with the revised protocol. The key differentiator seems to be patient selection criteria. Has anyone else noticed the correlation with BMI thresholds?
Great point. I'd push back slightly on the conclusion, the sample size in the cited study is too small to draw population-level inferences. That said, the directional signal is compelling and worth a larger RCT.
We implemented a similar approach last year. Early results are promising but we're still gathering 12-month follow-up data. Happy to share our protocol if anyone is interested.
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