WASHINGTON — Young adults are more likely than are adolescents to be uninsured, attorney Abigail English said during a meeting sponsored by the National Institute for Health Care Management Foundation.
“As you move up the age groups you move into higher and higher rates of uninsurance,” said Ms. English, director of the Center for Adolescent Health and the Law, Chapel Hill, N.C. “Adolescents fare better.”
According to 2004 census data, 8.8 million young adults (31% of 18- to 24-year-olds) were uninsured. By comparison, 3.2 million adolescents (12.5% of 12- to 17-year-olds) were uninsured in the same year. Of those numbers, 2.3 million uninsured young adults aged 18–24 (nearly 45%) were at income levels at or below 100% of the federal poverty level. This is double the percentage of uninsured adolescents aged 12–17 (0.9 million, or 22%) who were at or below the 100% federal poverty level in 2004.
Several factors contribute to young adults being uninsured, Ms. English said. Public programs such as Medicaid and the State Children's Health Insurance Program (SCHIP) usually end coverage at age 19 years, and most employer-based coverage for dependents ends at age 18 years unless the dependent is a full-time student.
In addition, the cost of individual policies for those not covered by public health insurance or employer-based programs has been prohibitive, Ms. English said.
States, in recent years, have made efforts to accommodate the insurance needs of young adults, she noted. For example, in 2002 about 40% of the states provided Medicaid coverage for very-low-income adolescents and young adults up to ages 19, 20, or 21.
Young adults leaving foster care have some options available to them to receive Medicaid, such as the Foster Care Independence Act of 1999 Medicaid expansion option, which allows states to provide Medicaid coverage up to age 21 years for former foster youth.
Some insurers have pioneered individual health insurance plans for young adults. For example, Blue Cross of California offers “Tonik,” a health plan with three types of low-cost options for young adults with active lifestyles. A specific perk is the low monthly premiums, which range from $64 to $123. San Francisco is piloting a program that targets low-income people aged 19–24 years who have aged out of public health insurance or have no employer-based coverage.
Congress has missed some opportunities to provide more universal coverage options for young adults and adolescents, Ms. English said. This includes the MediKids Health Insurance Act, which would have offered coverage for all children, adolescents, and young adults from birth to age 23 years, and the Medicaid/SCHIP Optional Coverage for Young Adults Act of 2003, which proposed a state option to offer public coverage to low-income youth up to age 23. Neither bill was enacted.
Utah currently has a mandated benefits law, which requires all employer-based insurance with dependent coverage to offer insurance to unmarried dependents under the age of 26 years. The Federal Employee Health Benefits Program, which currently offers coverage to unmarried dependents under age 22 years, could cover 800,000 more people if the program extended coverage to those who are 23 years old, she said.
But there are obstacles that threaten expansions to insurance coverage for young adults, Ms. English said. This includes the federal deficit and debt, state budget problems, increased health costs for employers, and cuts and restructuring in Medicaid and SCHIP.
Policy options do exist for increasing health care insurance for young adults, Ms. English said. “Advocacy and political [action] will be required to protect existing coverage and expand coverage for these vulnerable young people.”