This policy brief from the Robert Wood Johnson Foundation and Health Affairs examines the critical issue of enrolling uninsured young adults in health insurance coverage. According to 2008 Census data, 37 percent of individuals ages 19-25 are uninsured, and 25 percent of individuals ages 26-35 are uninsured. The enrollment of these so-called “young invincibles” also is vital to the success of the Patient Protection and Affordable Care Act (ACA) because they are generally healthier (and are less likely to use health care services) and will therefore balance the risk pool and costs of insuring older and sicker uninsured individuals.
Young people are at a critical stage in their lives, when long-term health risks, such as obesity, sexually transmitted disease, and tobacco use, often present themselves, and when early medical intervention can make a real difference. Uninsured young adults without insurance are two to four times as likely as their peers to forgo treatment for medical problems. Lacking proper health insurance can also lead to long-term financial problems if substantial medical debt is incurred. Now, in addition to having new ways to access affordable insurance, young adults will find that those plans offer better coverage. For example, many preventive care visits, which young adults are likely to need more than treatment for illnesses, are covered entirely.
Under the ACA, individuals can remain on their parent’s family coverage until age 26. Low-income young adults are eligible for Medicaid (in the 25 states and District of Columbia that have chosen to expand Medicaid). Young adults with low and moderate incomes have the highest rates of uninsurance. A Commonwealth Fund tracking survey found that 59 percent of young adults with incomes under 133 percent of poverty either were uninsured or had been uninsured at some point in 2013. In the 25 states without the Medicaid expansion, young adults with incomes under the poverty level ($11,490 for an individual in 2013) will not be eligible for either Medicaid or federal premium tax subsidies through health insurance marketplaces and are at the greatest risk of remaining uninsured.
Finally, the individual mandate to purchase insurance through health insurance marketplaces is intended to drive uninsured young adults (and other uninsured individuals) to purchase health insurance when their employers or families do not provide them coverage. Those with incomes of 133-400 percent of the federal poverty level, including many young adults entering the workforce for the first time, will be eligible for premium tax credits to lower the cost for coverage through the exchanges. The Young Invincibles, a nonprofit, foundation-supported advocacy group, estimates some 9 million individuals ages 18-34 could be eligible for premium tax credits.