Young Americans and Health Insurance
14 01 08 - 11:23
Why young people should demand change to our health care system.
By Rebecca Mansbach
January 14, 2008
Health insurance hasn't traditionally been considered a pet issue of young Americans. Conventional wisdom says that young people are not farsighted enough to worry about their long-term health or politically engaged enough to care about the state of the country's health care system. Fortunately, recent polls have proven that view to be drastically outdated.
In a survey of 2,526 young people taken this fall by Harvard University's Institute of Politics, one in 10 respondents ranked health insurance as the national issue that concerns them the most—only the war in Iraq trumped it as a more pressing concern. A poll conducted by Rock the Vote turned up similar findings, while the Kaiser Family Foundation has reported that 42 percent of young people are very worried about the price of health care. And it's no wonder: Young Americans are one of the most neglected demographic groups when it comes to health care. While young adults account for only 17 percent of the U.S. population under the age of 65, they disproportionately make up 30 percent of those Americans under the age of 65 who don't have health insurance.
A smattering of new state laws is helping to plug the holes that make it difficult for young adults to obtain health insurance. But further reform is needed, and, in the meantime, millions of young adults will continue to cross their fingers, hope for the best, and inevitably turn to the emergency room as a last resort.
The “Invincibles”
Young adults are commonly ignored in discussions about health care reform. The so-called “invincibles” are ordinary young adults, typically ages 19-29, who go without health insurance. According to an issue paper from the National Institute for Health Care Management, 91 percent of 18 to 24 year olds reported that their health status was “excellent,” “very good,” or “good”
in 1994. Many choose not to pay for health insurance because they believe they had a very low chance of getting sick or injured. Even so, young people report a large number of cost-related health care problems, such as foregoing needed care, failing to fill a prescription because of cost, and skipping preventive care because they lack coverage.
Even for the “invincibles” who acknowledge they need coverage, health insurance can be difficult to obtain. When it comes to health care, an individual's 19th birthday is a defining moment. This is the age at which he or she may no longer qualify as a dependent under his or her parents’ employer-sponsored insurance and no longer qualifies for public insurance programs such as the State Children's Health Insurance Program, also known as SCHIP, and Medicaid. At age 19, an American's risk of being uninsured more than doubles; the percentage of uninsured Americans rises from 12 percent for those 18 and younger to 31 percent for those between the ages 19 and 29.
Under many employer-sponsored family plans, only full-time students can receive coverage, leaving part-time students and those who are not in school ineligible. The Commonwealth Fund noted that nearly 60 percent of employers who offer coverage do not insure dependent children over 18 or 19 if they do not go to college. Furthermore, 40 percent of part-time or non-students aged 19 to 23 are uninsured while only 20 percent of full-time students are uninsured.
Working young adults are often hard-pressed to find health care. Entry-level jobs are typically low-paying and often do not provide benefits. Nearly half of young adults with jobs are not offered coverage. Young adults also tend to face a more transitory job market, which makes it more difficult to maintain coverage even when employers do provide it. In addition, working young adults are more than twice as likely as older adults to live in poverty, and therefore are unable to afford health insurance if they are not offered it within the workplace.
Health Care Risks
Young adults are particularly vulnerable to a host of health-related hazards like injury, homicide, and substance abuse. According to the Journal of Adolescent Health, young people get injured more often than any other demographic. Car accidents, for example, are a leading cause of mortality for young adults.
Young people also face a high risk for problems related to sexual reproductive health. The prevalence of many sexually transmitted infections, especially chlamydia, gonorrhea, and human papillomavirus peaks during this age, and in 2000, young adult females aged 20 to 24 had the highest pregnancy rate.
Young Americans are at risk for binge drinking and other kinds of substance abuse. The risks for cigarette use and eating disorders peak during young adulthood.
Mental health is a concern for individuals aged 18 to 24. Three-fourths of all lifetime cases of diagnosable mental disorders begin by age 24. According to the Journal of Adolescent Health, young adults have triple the suicide rate of adolescents.
The NIHCM Foundation reports that increasing numbers of young adults are overweight or obese today. There are also an increasing number of young adults living with chronic medical conditions or disabilities. In 2003, disability affected one out of every 15 young adults between 16 and 20 years old.
The States as an Imperfect Model
Even with all of the risks associated with being young, 19 to 23 year olds have the lowest per capita health expenditures of all age groups—approximately $1,600 per person. Some states are beginning to recognize this, and in recent years many have adopted policies to better provide coverage to young adults.
In May 2006, New Jersey began requiring most group health plans to cover single adult dependents until they are 30 years old. Since January 2006, Colorado has required group and privately purchased individual health plans to cover unmarried dependents until the age of 25. As part of Massachusetts’s April 2006 health care expansion law, young adults are considered dependents for insurance purposes until the age of 26 or for two years after they are no longer claimed as a dependent on their parents’ tax return, whichever comes first.
As of September 2003, full-time students are covered under their parents’ insurance in Texas until the age of 25. And New Mexico’s insurance policies provide coverage for dependents until they’re 25, regardless of school enrollment. (All these policies are summed up here.)
It is clear that in the past the “invincibles” have been invisible in health care reform. However, new policies are starting to provide coverage for these young adults. But these policies need to both become more widespread and provide preventive care for a gamut of illnesses and care common in young adulthood. Further progress is still necessary, especially for improving coverage that matches young adults’ needs.
Rebecca Mansbach is a senior at George Washington University and a former health policy intern for the Center for American Progress.