Young and Uninsured

Think about your plans for the next four years. Do they include going without health insurance?

Perhaps they should. A study published by the Commonwealth Fund [PDF] projects that if past patterns continue, two-thirds of all Americans between the ages of 19 and 29 will lack health insurance at some point in the next four years. In 2003, the most recent year for which data is available, over 30 per cent of 19- to 29-year-olds didn’t have health coverage, almost double the rate of 30-64-year-olds who lacked coverage in the same year.

This makes 20-somethings the age group with the lowest rates of health insurance coverage in the country. While children’s health and retirees’ prescription benefits are often prominently featured in public policy discussions, these groups are in fact covered at far higher rates than young adults. This is often because children and the elderly are eligible for Medicaid and Medicare; young people, considered among the healthiest segments of the population, are more often ineligible for public programs.

They are also the most unstable, a factor that contributes greatly to their difficulty in obtaining insurance coverage. Nationwide, over half of all employers who offer health coverage for employees and their dependents will not cover dependents who are over 18 or 19 and do not go on to post-secondary education. Young people who received public health coverage as children are also likely to age out of the system at 19. Young adults who are able to maintain health coverage through college are often only delaying the loss of coverage until graduation.

Sara Collins, senior program officer at the Commonwealth Fund, points out that within this age group, issues of income and poverty are also very much at play. “This is a relatively low-income group of people that doesn’t have access to health insurance,” she said. “Seventy-two per cent of uninsured young adults are under 200 per cent of the poverty line.” What this means is that even those uninsured young adults who are not below the poverty line are still close enough to poverty to be considered highly vulnerable.

When a young person does not attend college and enters the labor market, the types of jobs they are qualified for tend to not offer benefits. Even young adults who do graduate from college are likely to work temporary or part-time jobs, work for smaller firms, and change jobs more frequently -- all of which lessen their chances of being offered health insurance through work.

Collins says that it is largely due to these factors -- income and employment status -- that young adults find themselves with or without health insurance. A competing theory, which argues that young people view themselves as invincible and don’t see coverage as an important issue, is largely unfounded, says Anthony Wright, executive director of Health Access California.

“There’s a myth of the ‘young immortals,’ people in this age group who believe they’ll live forever so they don’t need coverage,” Wright said. In fact, available statistics counter the presumption that young adults don’t value health insurance. When adults ages 19-29 are offered coverage, they generally accept it at the same rates as people in older age groups.

“If you actually control for income and type of jobs, young people take up coverage as much as any other age group. So if they turn down health coverage, they do it because they can’t afford it,” Wright said.

A Commonwealth Fund survey also found that 70 percent of young workers say that health insurance is an important factor for them when they choose a job, a figure comparable to other age groups. So does the ‘young immortal’ theory carry any weight? Wright believes that while there is some truth to it, it pins the responsibility on individuals, rather than on the system that excludes them. “I’m not saying you can’t find individual people who have this [young immortal] world-view,” he said. “But that’s not the problem with our health system.”