Affordability, not perceived lack of need, is the major barrier to health insurance coverage for many young adults, according to a survey from the Commonwealth Fund.
"There is a stereotype that young adults believe they are ‘invincible’ and don’t want or need health insurance," Commonwealth Fund vice president Sara Collins, the study’s lead author, said at a briefing. "This survey shows that is a myth. A typical uninsured young adult is from a low- or middle-income family and works a low-wage job. In general, young adults value health insurance but cannot afford it."
Fewer 19- to-25-year-olds are uninsured this year – 34% vs. 43% in 2011 – mostly due to Affordable Care Act provisions that allow them to stay on their parents’ insurance plans until age 26.
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In general, young adults value health insurance but cannot afford it, said Commonwealth Fund vice president Sara Collins.
However, these young adults have little overall awareness of the health insurance exchanges and options they will offer. At the time of the survey (March 2013), only 27% of young adults knew health insurance exchanges would open Oct. 1.
The survey, which compared results against a 2011 survey, also found that in states that are not expanding their Medicaid programs, low-income young adults may fall through the coverage cracks.
When offered coverage through an employer, 67% of young adults surveyed said they signed up. Among the third who did not, 36% were covered by their parents’ policy, 22% said it was too expensive, 19% were covered by a spouse or partner’s insurance, 4% had purchased coverage on their own, and 13% had other reasons. Only 5% said they did not want or need insurance; the remainder did not answer.
These young adults are viewed as key to making the ACA’s health insurance exchanges work. Generally healthier, they will help spread risk and keep premiums lower for all participants in the exchanges.
But the Commonwealth Fund survey found that states and the federal government have much work ahead of them to increase knowledge of exchanges in this age group, especially among those who have been recently uninsured or who have lower incomes.
Seventy-nine percent of those with incomes below 133% of the federal poverty line responded that they had not heard of the health insurance exchanges. The exchanges will be required to offer coverage to people with incomes up to that level, and subsidies will be available for buyers who are at 100%-400% of the poverty line.
The Commonwealth Fund estimated that 82% of young adults who have spent some time being uninsured would be eligible for those subsidies.
The Commonwealth Fund Health Insurance Tracking Survey of Young Adults was conducted by an online research firm in 2011 and 2013, among a representative sample of young adults. In 2011, 3,438 adults aged 19-29 were randomly sampled; 1,863 responded (54%). In 2013, 3,530 young adults were surveyed; 1,885 responded (53.4%). Just over 1,000 responded in both years.
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