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New efforts to insure young adults may beat reform

One of the largest groups of uninsured in the country today is young adults—those aged 19–26. Although they make up about 18% of the adult population, they account for up to 28% of the uninsured: an estimated 10.3 million young adults—or about one in three (32%)—lacked health insurance coverage this year, according to figures from the Urban Institute.

“Because young adults face so many transitions—graduation, job changes, and in this economy, unemployment—they are especially vulnerable to the risks of being uninsured,” Commonwealth Fund President Karen Davis said earlier this summer in response to a study of this group. Davis noted that “comprehensive health reform would go a long way toward ensuring that young adults have stable, affordable health coverage” that would give them access to the care they need.

It appears that the dilemma of young people has not been far from the minds of health reform–makers on Capitol Hill. For example, in the healthcare reform bills approved by the Senate Health, Education, Labor, and Pensions Committee and the House, provisions were included that call for:

  • Allowing young adults to stay on their parents’ health insurance policies until age 26—during the years when they are least able to afford their own coverage
  • Using an insurance exchange to give young adults the option of enrolling in lower-cost insurance plans—with recognition that young adults often have few health needs and are less able to afford coverage at the start of their working careers
  • Making health insurance available to those without job‑based coverage, with premium assistance available to those who can’t afford it

However, even if reform measures are approved at the federal level, it will take time for these provisions to be enacted. Actions have been going on elsewhere to provide younger individuals with healthcare coverage.

Earlier this summer, New York became one of about two dozen states requiring commercial insurers and managed care organizations to offer an option to continue coverage for unmarried young adults—in this case, through age 29—regardless of financial dependence under a parent’s group health insurance policy. This adult child does not have to be a student, must not be eligible for other coverage, and must either work or reside in the state.

Florida, New Mexico, and Washington also have extended insurance coverage to adults who are not students up to age 25. In Florida, a provision is available to extend that coverage until children reach age 30.

But changes also are occurring at the collegiate level. For example, at 11 campuses of the University of North Carolina (UNC) this fall, students who do not have their own coverage or coverage through their parents will be required to have coverage, which can be obtained through a new plan “designed to leverage the UNC system’s buying power,” according to UNC. This coverage will be factored into financial aid packages.

Students will have a $300 deductible and be covered for up to $100,000 under the UNC package. A 2008 study by the General Accountability Office found that more than half of collegiate plans had a maximum benefit of less than $29,000.

Young adults who are not in school full‑time after graduation from high school are much more likely to be uninsured primarily because it is much more difficult for them to obtain access to employer coverage: 37% of part‑time and nonstudents aged 19–23 were uninsured, compared with 18% of full‑time students, according to a recent study from The Commonwealth Fund.

“Loss of health insurance coverage impedes young adults’ access to the health system at precisely the time they should be establishing their own relationships with physicians and puts them and their families at significant financial risk,” said study author and Commonwealth Fund vice president Sara Collins.

Although young adults are healthier than older adults, about 15% have chronic conditions such as asthma, and more than half weigh more than what is considered to be healthy. In addition, 2.7 million births are attributable to women in this age group, and young adults have the highest rates of injury-related visits to the ER of any age group, according to the study.

In the absence of comprehensive change or reform in the health insurance system, the following three policy changes could “incrementally extend coverage” to a portion of uninsured young adults and prevent others from losing coverage in the future, according to the study:

  • Extending eligibility for Medicaid/State Children’s Health Insurance Plan public coverage beyond
    age 18.
  • Having states ensure that all colleges and universities require full‑ and part‑time students to have health insurance and offer health insurance coverage to both.
  • Extending eligibility for dependents under private coverage beyond age 18 or 19.