Major Finding: About half of uninsured young adults will get health insurance coverage by 2014, and most others in that group will be eligible for premium subsidies under the new health insurance reform law, which may enable them to seek needed care and alleviate debt.
Data Source: Commonwealth Fund Survey of Young Adults, 2009
Disclosures: No disclosures were reported.
Health reform could benefit young adults more than any other uninsured group, expanding coverage to almost all 13.7 million of them through a combination of insurance reforms, subsidies, and Medicaid expansion, according to a new report from the Commonwealth Fund.
Provisions of the recently passed Affordable Care Act that extend coverage of young adults as dependents to age 26 years probably will cover about 1.2 million of that population by the end of 2011. Extending Medicaid eligibility could provide coverage to another 7.1 million young people, beginning in 2014, the Commonwealth Fund report said.
Furthermore, combining premium subsidies with opportunities to purchase coverage via a health insurance exchange will provide the remaining uninsured young adults (defined by the report as those aged 19-29 years) a chance to obtain affordable coverage beginning in 2014.
“The benefit of the Affordable Care Act of 2010 for young adults cannot be overstated,” Sara Collins, Ph.D., lead author of the report, said during a press briefing. “All told, the provisions have the potential to cover 13.7 million young adults,” or the same number that were uninsured in 2008.
However, that figure probably underestimates the current number of uninsured young adults, as unemployment has risen dramatically in that population since 2008.
Health care costs represent a significant problem for this group, whether or not they are insured, according to the report. A total of 76% of uninsured young adults and 37% of those with insurance went without needed care in 2009 because of its cost, the report said.
One-third of all uninsured young people—and 46% of those who both are uninsured and have chronic health problems—reported that their health declined because they delayed getting medical care.
In addition, 60% of young adults without insurance had trouble paying medical bills in 2009, compared with 27% of their insured peers, according to the report.
Medical debt also is a problem, the report found, with 11.3 million young people who are trying to pay it off. Half of those had asked family for financial help, whereas 39% said they were unable to meet other financial obligations such as student loans because of their medical debt.
More than half of the 13.7 million uninsured young adults are in families with incomes that will make them newly eligible for Medicaid under the health care reform law. Another 30% are in families whose incomes will qualify them for health insurance premium subsidies so they will not have to spend more than 3%-8% of their income on health insurance premiums. And 12% live in families whose incomes will qualify them for health insurance–premium subsidies so they won't have to spend more than 9.5% of their income on premiums, the Commonwealth Fund study found.
Fewer than 1 million uninsured young adults are expected to have incomes that are too high to qualify for premium assistance, the study authors said.
Many of those who will become newly insured through the law's provisions probably will seek care from primary care physicians rather than getting free care from emergency departments, noted Dr. Collins, the Commonwealth Fund's vice president for affordable health insurance.
This has the potential to help primary care physicians because “these people will be coming in with insurance cards” that will cover much of their care.
“A lot of people have been getting free care,” she said. “Now, providers will be reimbursed for care.”
It's not clear whether the new law will lead to a significant shortage of primary care physicians to care for the influx of new patients, but Dr. Collins said that the law authorizes a significant increase in funding for community health centers, which could take up some of the slack.
The report, “Rite of Passage: Young Adults and the Affordable Care Act of 2010,” was based on federal health insurance data and a national telephone survey of 2,002 young adults.