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Obamacare's success hinges on 'young and healthy' purchasing insurance

Jason McCool, an adjunct music professor at Montgomery College in Maryland, doesn’t receive health-care insurance through his workplace, making him an important player in the implementation of President Obama's health-care law.

“I actually haven’t been to a doctor in 10 years,” said McCool, who’s in his 30s. “I try to keep in good shape and all, but you never know if there’s going to be a car accident or something.”

McCool isn’t alone. According to estimates, nearly one-third of the nation’s uninsured are young and healthy Americans. And success – or failure – of President Barack Obama’s health-care law largely depends on their participation.

“There’s pretty broad agreement that new health care exchanges can’t work if we don’t get broad participation in the system,” says Robert Zirklbach, a spokesperson for America’s Health Insurance Plans, better known as AHIP.

Enrollment for the exchanges begins on Oct. 1.

“If the younger people simply decide not to purchase health insurance until they need it, that’s going to actually increase costs for everyone, both those who are young as well as those who are old,” Zirkelbach adds. “Getting young people in the system is good for everybody, and it’s good for the long-term sustainability of the new health insurance exchanges.”

Under the new law, those who choose not to purchase health care insurance must pay a $95 opt-out fee or 1 percent of their respective income – whichever amount is larger.  But what’s still unclear is whether or not this is a harsh enough penalty to encourage participation.

“I don’t think that people are going to be terribly happy about paying something for nothing, so I think that the result will be that they’ll probably end up purchasing,” says McCool.

But he acknowledges that buying insurance will cost him money – maybe as much as $200 to $300 per month.

“Frankly, I don’t make enough money to justify that,” he said. (However, under the health-care law, someone in McCool’s income range would qualify for subsidies that could cover as much as 29 percent of his overall premium, according to the Kaiser Health Care calculator.)

Who are the uninsured?

A government marketing analysis by the Centers for Medicare and Medicaid Services, better known as CMS, broke the uninsured into six groups that it believes are critical in making implementation of the new law successful:

1.The “Young and Healthy,” who have the lowest tendency to enroll, take their good health for granted and are likely to wait on purchasing health care until they feel they need it.

2.The “Sick, Active and Worried,” who are cost-conscious and likely to seek information about health care, but tend to have difficulty understanding the system.

3.The “Passive and Unengaged,” who are likely not to understand the health care system and fear making “wrong decisions.”

4.The “Informed, Healthy and Educated,” who feel that health care information is important, are in good health, and keep themselves informed.

5.The “Mature and Secure,: who are generally older in age, feel that health care information is important and use preventative measures.

6.The “Vulnerable and Unengaged,” who are not in ideal health, but feel that health care information is not important.

According to the analysis, the “Young and Healthy”, “Sick, Active and Worried” and “Passive and Unengaged” make up the majority of the uninsured. 

While the “Young and Healthy” group is the least likely to purchase health care, a Kaiser health tracking poll finds that 77 percent of people ages 18-25 and 71 percent of people ages 26-30 say they feel that health care is “very important” to have. The deterring factor – cost. Roughly two-thirds of those ages 30 and younger say that they worry about being able to pay for medical bills due to a “serious illness or accident” and more than 40 percent say that they worry about being able to pay bills for “routine care”.

In order to encourage participation in October, organizations like Young Invincibles – dedicated to encouraging health-care enrollment among the young and healthy – will be taking an active role in informing the public about the new system through outreach programs.

Jen Mishory, the group’s deputy director, tells NBC News: “We’re going to be doing events across the country. In some states, we’re going to be doing enrollment events. In some states, we’re going to be doing we’re actually partnering with community colleges and local groups that actually work with young people, telling them what’s going on and then helping them to put on outreach events to educate this generation.”

And it will be targeting people like McCool.

“Nobody doesn’t want health-care coverage,” McCool says.  “I think a lot of us are very, very excited about the changes that [the health-care law] is going to bring about, because it’s going to open the door that previously had been locked for many of us.”

As it turns out, McCool will be getting health insurance this fall – as he returns to school for a Ph.D. in musicology at Boston University, where he will be receiving a full scholarship through a fellowship program.

But after school, he says he plans to enroll in a health exchange if his next job doesn’t offer health insurance. “Even if I wasn’t going back to school this fall, I’d probably be enrolling.”

But for health care to work, those probablys must become definitelys.

NBC’s Karley Schledwitz contributed to this article.