Two months before President-elect Donald Trump begins hisattempt to repeal the Affordable Care Act, the Obama administrationand its allies are making an aggressive final push to sign-up someof the program’s most reluctant customers -- young people.

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Related: Obama ramps up campaign to enroll young people inACA

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Healthy and new to the workforce, the “young invincibles” -- people aged 25 to 34 --represent the highest uninsured rate of Americans, according to asurvey released in November by the Centers for Disease Control andPrevention. While coverage of people in that range has grown underObamacare, the group has for the last five years had the highestrates of uninsurance compared to other age bands.

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Their participation is critical to the law’s future, politicallyand as a way to stabilize its insurance markets. The young andhealthy offer not only a constituency of supporters, they can alsohelp balance the cost of older, sicker people.

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“The more people that enroll this year, the harder it will be torepeal or replace the law,” said Larry Levitt, senior vicepresident at the Kaiser Family Foundation, a health research andadvocacy group. “If enrollment doesn’t grow, particularly amongyoung and healthy people, it could undermine the entire insurancemarket.”

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Enroll America, an Obamacare advocacy organization that’s beencentral to sign-up efforts, said its working with the U.S.Department of Health and Human Services and more than 15 otherorganizations to go after young people online and in person.

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Groups are holding sign-up events at restaurants and bars todraw a younger crowd; and more than 350 colleges and universitieshave signed up for this year’s on-campus sign-up efforts.

Reluctant to enroll

Despite those efforts, advocates for the law still haven’tcracked the code to get America’s youth insured. Some find the costof Obamacare plans unaffordable, while others haven’t found a planthat works for them.

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Megan Tice-Royea, 29, didn’t sign up for health insurance lastyear. “I’ve always been a healthy person,” Tice-Royea said in aphone interview. She works 40 hours a week as a manager at a familygrocery store in Newport, Vermont, a job that pays $14 an hour. InSeptember, she was admitted to the hospital with a gallbladderinfection. The surgery left her $32,000 in debt.

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“I knew I couldn’t afford it,” she said. “It was a life-or-deathsituation.” Now she’s considering signing up for an insurance planthrough Obamacare, but only if it will help pay off her earliermedical bills. “I feel like this is the only way to go. I just wishwe had better options.”

Unstable market

Millions of people have gained coverage under Obamacare,bringing the uninsured rate to a near-record low. At the same time,premiums for insurance plans in the program are rising rapidly --by an average of 22 percent next year for mid-level plans,according to a report from the U.S. Department of Health and HumanServices. Part of the blame for the rising premiums is the failureto attract the young and healthy.

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Trump has attacked the cost of plans under thelaw as bad for the youth. “This is particularly unfair tomillennials and younger Americans generally who will be totallycrushed by these massive health-care costs before they even getstarted on their journey through life,” Trump said in a Nov. 1speech. He’s promised to repeal and replace or amend Obamacare asone of his first acts in office.

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Basic health insurance plans under the law can protect againstcatastrophic expenses like Tice-Royea’s bills, but also oftenfeature deductibles that require spending thousands of dollarsbefore most coverage kicks in -- leaving many young people toquestion the value of what they’re buying, especially at an early,lower-earning stage of their time in the workforce.

Worth it?

Even after her surgery, Tice-Royea is still unsure she wants tobuy insurance.

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“The deductible is super high, so the only way it would benefitme is if I had another surgery,” she said.

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Related: High deductibles leading to health careavoidance

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For others, getting insured isn’t a priority -- at least notcompared to their other obligations. In October, Mark Bertolini,the chief executive officer of health insurer Aetna Inc., said that“young people can do the math. Gas for the car, beer on Fridays andSaturdays, health insurance.”

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Maria Puche, 23, is a student and part-time worker in Irving,Texas. She lost her insurance three months ago when her motherswitched jobs.

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“It’s hard for me to take classes, work, and pay for everythingat the same time.” she said. “I’m trying not to get sick.” With allof that, she said she hasn’t had time to think much about signingup for health insurance on her own.

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That’s not uncommon, said Ebonee Rice, national strategicpartnerships director at Enroll America. Many people don’t knowabout available assistance -- even though about 77 percent ofcurrent enrollees can find a plan for less than $100 a month whentax subsidies are taken into account, according to the Departmentof Health and Human Services.

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Related: How Trump could crush the ACA without arepeal

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“When young people have to choose between paying student loansand paying health insurance,” Rice said, “it seems like the easieroption is to pay attention to more pressing things.”

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Copyright 2018 Bloomberg. All rightsreserved. This material may not be published, broadcast, rewritten,or redistributed.

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