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11-06-2012 | Article

US young adults ‘still underinsured’


Report brief

MedWire News: Nearly two-fifths of young adults in the USA had no health insurance for all or part of 2011, giving them the dubious distinction of having the highest uninsured rate of any age category, find authors of a new report.

Although one of the earliest provisions of the Affordable Care Act, derided by some as "Obamacare," has allowed an estimated 13.7 million Americans aged 19 to 25 years to remain on or join their parents' health plans, 39% of all US residents from 19 to 29 years still went without health insurance for some or all of 2011, according to Sara Collins and colleagues from The Commonwealth Fund.

Drawing on data from a Commonwealth Fund tracking survey, Collins et al found that of those who had lost a job in the past 2 years, 52% lost their insurance, 14% were able to go on their parents' insurance, 16% went on COBRA (Consolidated Omnibus Budget Reconciliation Act) extension, and 18% went on their spouses' or partners' insurance or found insurance through another source.

Among all participants in the survey, 28% said they had problems paying or were unable to pay medical bills, 16% had been contacted by a collection agency for unpaid bills, 16% had to "change their way of life" to pay a medical bill, and 20% were paying off the debts over time. More than one-third (36%) reported having any medical bill problem or debt in the past year.

"Burdens like these are eating in to the already stretched resources of young adults, particularly those with lower incomes," the authors write in the report, titled "Young, Uninsured, and in Debt: Why Young Adults Lack Health Insurance and How the Affordable Care Act Is Helping."

"Affordability, rather than a belief that they do not need insurance, has been the major barrier to young adults gaining insurance coverage in the United States. Indeed, the millions of young adults who have joined their parents' policies in the past 2 years as a result of the Affordable Care Act demonstrate the importance of health insurance to this age group," they continue.

The report notes that beginning in 2014, young adults without the option of joining their parents' health plans will be eligible for a variety of insurance options that include expanded Medicaid eligibility and subsidized private health insurance for those with incomes up to 400% of the federal poverty level (maximum annual income levels of $ 43,560 for singles, and $ 89,400 for a family of four).

The authors stress that although many young people feel invincible, health insurance is important for young adults, especially women.

"When young adults experience gaps in health insurance, their ties with primary care physicians are weakened, often at precisely the time they should be forming stronger links to the health care system and taking responsibility for their own care," Collins et al write.

They note that young adults have more frequent emergency department visits than either children or older adults, and that adults from the ages of 20 through 24 have the highest rate of new HIV infections of any age group (37 per 100,000 in 2009).

Additionally, 15% of young adults from the ages of 18 to 29 have arthritis, asthma, cancer, diabetes, heart disease, or hypertension, and 52% are either overweight or obese.

"It is imperative that state and federal policymakers press forward in implementing the remaining coverage expansions in the reform law, to free young adults across the income spectrum to pursue their educational and career aspirations while maintaining both their health and economic security," Collins and colleagues conclude.

By Neil Osterweil