With lower expectations of and satisfaction with health care, Millennials in America seek three things: available, accessible, and affordable services, research from the Transamerica Center for Health Studies has found.

Far and away the top reason for not obtaining health insurance in 2018 was that it was simply too expensive, cited by 60% of Millennials. Following that, 26% of Millennials noted that paying the tax penalty plus personal medical expenses were, together, less expensive than available health options.

While Millennials were least likely to visit a doctor’s office in the past year, they had the most likelihood of making a visit to a mental health provider, to seek chiropractic care, urgent care, and acupuncture — all services delivered outside of traditional medical home settings.

When a Millennial patient needs health care services, s/he tends to dip into savings, use a credit card, or withdraw funds from a 401(k) account to pay for medical spending.

Millennials value employer-sponsored healthcare and wellness benefits, Transamerica found, with over one-half of these workers sticking with their companies because they need the health insurance offered on the job. Conversely, 4 in 10 Millennial employees said they’d left a previous job because their companies didn’t offer health insurance and benefits. This generation has greater engagement with employers that offer health benefits.

Thus, one-fifth of Millennials are not satisfied with the healthcare system.

Millennials are most likely across generations to track health policy news, with 6 in 10 concerned about potential changes.

Millennials’ biggest fear in the health policy debate is losing access to health care, especially due to a pre-existing condition. This worry is commonly-held across the generations, including Gen X and Boomers alike.

As a result, the most important health-related priority among Millennials is to stay healthy and attend to prevention. Closely related for a majority of Millennials is to take on self-care across all health care needs” physical, mental and emotional health. In third place, 1 in 3 Millennials is committed to make personal health changes.

Health Populi’s Hot Points: It’s becoming clearer that younger people in America don’t have the same value for a personal medical home that older health consumers share. Millennials’ more frequent visits to chiropractic and other retail health touchpoints demonstrates the expressed demand for those services — which are largely not covered by health insurance and are, therefore, more “consumer-directed” than traditional health care sites that lack transparency and convenience vis-a-vis these other services.

This is a wake-up call for the legacy healthcare system — hospitals, physicians, health insurers and traditional pharma. Millennials have begun to vote with feet and pocketbooks in favor of self-care, prevention, and integrative medical/health services.

Another lens on this research are the implications for health policy and politics. The erosion of the Affordable Care Act, Obamacare health insurance marketplaces, and access to and availability of women’s preventive health provisions in the ACA has led to greater awareness among American women on the state of health insecurity. This third chart, curated from the Transamerica research, shows that fewer Millennial women were saving for healthcare expenses compared to men. Furthermore, fewer younger women could afford routine healthcare expenses like deductibles, co-payments, and other out-of-pocket expenses, versus male peers.

An April 2019 Morning Consult poll found that women and lower-income adults are more likely to self-ration health care services due to cost than men or more affluent, urban dwellers were. Those data are shown in the bar chart here from the study.

Today, we hear that the State House of Alabama voted to ban virtually all abortions in the Heart of Dixie. We saw evidence that the 2018 mid-terms were, for many voters, the “health care elections,” Families USA characterized based on the demographics and issues driving turnout.

Health will continue to be a lightning rod for U.S. politics leading to the 2020 elections, especially driving women of working ages 18-64 to the polls to support health care coverage, job and pay equity, support for education, and children’s issues. Younger women, lower-and-middle income women will be especially motivated to be heard in polling places across the U.S.