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Guest column
Sara R. Collins, senior program officer, The Commonwealth Fund

Dr. Collins and colleagues issued a report this week: "Rite of Passage? Why Young Adults Become Uninsured and How New Policies Can Help.” She has contributed an excerpt here for discussion.

Young adults between the ages of 19 and 29 represent one of the largest and fastest-growing segments of the population without health insurance in the United States. Often dropped from their parents’ policies or public insurance programs at age 19 or on graduation day, they are left to find insurance on their own as they make the transition from high school to work or college.

Yet, jobs available to young adults are usually low wage or temporary - the type that generally do not come with health benefits. Young adults who are able to go to college full-time may have some protection through their parents’ policies, but upon graduation usually lose access to family coverage.

The number of uninsured young adults ages 19 to 29 climbed to 13.7 million in 2004, an increase of 2.5 million since 2000. Young adults were the fastest-growing age group among the uninsured over this period, accounting for 40 percent of the increase in the uninsured under age 65. Even though they  comprise just 17 percent of the under-65 population, young adults account for 30 percent of the non-elderly uninsured.

By far, the young adults most at risk of lacking coverage are those from low-income households. These individuals, like children and older adults in low-income families, are disproportionately represented among the uninsured. About 23 percent of adults ages 19 to 29 live in households with incomes below 100 percent of the poverty level, but two-fifths (40%) of the 13.7 million young adults who are uninsured live in households with incomes below poverty.

Nearly half of uninsured young adults are white. But Hispanics are disproportionately represented among the young and uninsured. While Hispanics comprise 19 percent of adults ages 19 to 29, they comprise 31 percent of uninsured young adults. Hispanics and African Americans are both at greater risk of being uninsured than white young adults: about 36 percent of African Americans and 52 percent of Hispanics ages 19 to 29 are uninsured, compared with 24 percent of whites in that age range.

Nineteenth birthdays are crucial milestones in Americans’ health insurance coverage. Both public and private insurance plans treat this age as a turning point for coverage decisions. Employer health plans often do not cover young adults as dependents after age 18 or 19 if they do not go on to college.

Public programs, such as Medicaid and the State Children’s Health Insurance Program, also typically have one set of income and eligibility standards for children and another for adults, with the 19th birthday as the critical divide.

Moving on and off coverage places the health of young adults at risk and  subjects them and their families to financial stress just as they are starting out in the workforce.

Three policy changes could extend coverage to uninsured young adults and prevent others from losing it: extending eligibility for Medicaid and the State Children's Health Insurance Program beyond age 18; extending eligibility for dependents under private coverage beyond age 18 or 19 regardless of student status; and ensuring that colleges and universities require full- and part-time students to have insurance, and that they offer coverage to both.

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Join the dialogue here

May 31, 2006 8:31:35 AM
sweet lou says

As the father of a 19 year old, I find this situation truly appalling. Luckily, my daughter is going on to college and so can access coverage. Actually, luck has little to do with it; it’s a financial sacrifice on her part (and our part) to access to further her education and affordable insurance is tacked on as a “benefit.” Too many younger folks and their parents do not have the financial luxury of spending tens of thousands of dollars each year for continuing education though, and too many can’t afford insurance either.

For young adults just starting out, health insurance is too often a distant dream. It certainly was for me. I worked in the food service industry for a decade and there simply was no health insurance available from employers. I banked on the invincibility of youth and it mostly held out until I was able to afford insurance, well into my thirties. One major incident, though, and I would have been financially ruined. The earning power of the younger demographic just simply does not equate to being able to afford insurance. And I find that so tragic, given that so many young couples are thinking about starting a family. Maybe that's why, at least it seems to me, so many folks are starting families later in life.

This is an excellent article that illustrates a shamefully ineffective part of the healthcare system. I urge people to read the full report.

Jun 7, 2006 12:10:38 PM
DeeAnna says

The statistic I would also like to see here is what percentage of the 19-29 population are underinsured. Many recent graduates often take jobs that provide only emergency coverage (like AmeriCorps) or are granted coverage but don't yet make enough money to be able to afford the co-pays or the percentage of the patient bill that they are responsible for.

Jul 5, 2006 5:50:15 PM
Vic says

Health Savings Accounts are the solution for the young, the uninsured and frankly most Americans when small business pooling arrangements become reality. Healthia.com provided my son with the best rates for his HSA and so far he is actually saving money and I am saving money on premiums. Great deal for all

Oct 22, 2007 12:29:23 PM
Lily says

I found a great prescription discount card at www.rxdrugcard.com. Low membership fee. Drug prices posted. Perfect for young adults when they are dropped by their parents' insurance.

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