The U.S. leads the pack in the percentage of older adults who have trouble paying their medical bills.
Heading into the final stages before implementation of his health care overhaul, President Obama is facing growing concerns among young Americans who will absorb the largest spike in medical costs under the sweeping law.
Obama championed his signature legislative achievement on college campuses and to twentysomethings during his re-election campaign. But he focused on Obamacare's most popular provision -- allowing students to stay on their parents' insurance plans until the age of 26 -- not the higher costs incurred by younger Americans to bring down the price of insurance for seniors.
Obama has long argued that once his reforms are enacted, the American people will embrace them. However, critics counter that the more people learn about the law -- especially young people -- the less they want the comprehensive change.
"The young folks who know what is coming down the pike are extremely concerned," said Evan Feinberg, president of Generation Opportunity, a national nonpartisan organization advocating for 18- to 29-year-olds. "It sounds great to stay on your parents' health care, but they're going to be forced to buy insurance they won't be using as much as older people. They need to read the fine print on the deal."
And with the country still divided over the most expansive overhaul to the health care system since Medicare, the president can ill afford any stumbles during the rollout of the program, some analysts said.
"The success or failure of Obamacare will rest on public legitimacy," said Jeremy Mayer, a political scientist at George Mason University. "The young people are the ones who are going to face what they might see as an unfair health insurance increase. Who will they blame?"
Starting Jan. 1, Obamacare will limit the premium prices of seniors relative to the rest of the population -- in other words, younger, healthier people will pay a greater share of health care expenses to fill the void.
It's not just critics of the president concerned about the early implications of Obamacare for the non-AARP crowd. Young Invincibles, a nonprofit group that advocated for the president's health care blueprint, is calling for administration officials to consider defining adults at a later age and including student health insurance in the broader risk pool.
"Young people have both a societal and individual interest in ensuring that older adults can also afford to purchase coverage, but young people may also simply choose not to purchase coverage if premiums are too expensive," the group recently wrote to federal health officials.
With such a development, younger people would pay a penalty for avoiding the so-called individual mandate coming in 2014. It would also leave the insurance pool older and sicker, undercutting one of the claims of Obamacare supporters -- that near-universal participation would drive down the cost of health insurance.
And for all the talk of how Obama's recent pushes on gun control and immigration reform will define his second term, health care, perhaps more than any issue, will shape the president's legacy, some said.
"If he did nothing but ensure the success of Obamacare, that'd still be one impressive legacy," said a Democratic pollster closely aligned with the White House. "On the flip side, if [Obamacare] goes poorly, I fear it will overshadow everything else."