Health Insurance Coverage of
Young Adults
John Holahan
The Urban Institute
February 4, 2008
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Health Insurance Coverage, by Age and Income
All Incomes
Age
19-26
Age
27-34
Age
35-44
Age
45-54
69.0
71.0
Age
55-64
80
Percent
70
60
67.4
62.1
48.9
50
40
31.6
30
20
25.6
18.9
10.3
9.2
10
7.5
15.3
9.6
13.0
12.7
0
Employer
Public Coverage
Uninsured
Source: Urban Institute, 2007. Based on data from the 2007 ASEC Supplement to the CPS.
Note: Excludes persons aged 65 and older and those in the Armed Forces.
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Health Insurance Coverage, by Age and Income
Less than 200% of FPL
Age
19-26
Age
27-34
Age
35-44
Age
45-54
Age
55-64
60
Percent
50
47.7
44.1
42.0
40
31.0
28.9
28.5
30
20
19.4
17.6
22.0
37.3
36.8
29.2
27.7
28.8
26.1
10
0
Employer
Public Coverage
Uninsured
Source: Urban Institute, 2007. Based on data from the 2007 ASEC Supplement to the CPS.
Note: Excludes persons aged 65 and older and those in the Armed Forces.
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Health Insurance Coverage, by Age and Income
200% of FPL and Above
Percent
Age
19-26
90
80
70
60
50
40
30
20
10
0
Age
27-34
Age
35-44
Age
45-54
Age
55-64
80.5
83.3
83.5
80.3
13.4
10.1
2.1
2.1
9.0
2.6
7.7
5.6
72.5
16.8
3.2
Employer
Public Coverage
Uninsured
Source: Urban Institute, 2007. Based on data from the 2007 ASEC Supplement to the CPS.
Note: Excludes persons aged 65 and older and those in the Armed Forces.
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Uninsurance Rates By Age and Income
Family
Poverty
Level
Uninsurance
Rate
Ages 19-26
Ages 27-64
Percent of Uninsurance
Population
Rate
Percent of Uninsurance
Population
Rate
<100%
29.9%
46.8
12.2%
44.9%
100%-199%
24.2%
40.9
14.6%
35.7%
200%-399%
27.0%
22.2
28.7%
16.4%
400%+
18.9%
9.0
44.5%
5.6%
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Compared With Older Adults,
Younger Adults Are
• More likely to be single without children
• Less likely to work full time and more
likely to be non workers
• More likely to be Hispanic
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Uninsurance Rate by Age and Health Status
Health Status
Uninsurance
Rate
Ages 19-26
Percent of Uninsurance
Population
Rate
Ages 27-64
Percent of
Population
Uninsurance
Rate
Excellent/
Very Good
75.4%
28.5%
61.9%
15.1%
Good
20.1%
41.5%
25.6%
22.5%
Fair/Poor
4.5%
38.6%
12.5%
22.3%
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Insurance Coverage of Young Adults by
Age, 2005-2006
All Incomes
Age 17
Age 18
Age 19
Age 20
50.5
48.7
Age 21
Age 22
70
Percent
60
59.2
57.8
50
44.8
46.1
40
28.5
30
20
10
31.6
26.5
15.7
18.3
13.5
14.4
11.4
9.6
32.6
8.9
8.4
0
Employer
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Medicaid and State
Uninsured
8
Uninsurance Among Young Adults, By
Student Status, Ages 19-24
(in millions)
Students
NonStudents
Total Young Adults
9.7m
14.5m
Uninsured Rate
19.2%
39.3%
Number of Uninsured
1.9m
5.7m
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Employer Sponsored Insurance: Offer
and Take-Up Rates, By Age, 2005
Age
Offer/
Eligibility
Take-Up
19-24
60%
75%
45%
54%
25-34
76%
81%
62%
72%
35-44
80%
83%
67%
80%
45-64
83%
86%
72%
85%
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Own ESI Any ESI
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Change in ESI Offers and Take Up Rates,
By Age, 2001-2005
(Percentage Point Changes)
Age
Change in
Offer/
Change in Change in Change in
Eligibility Take Up
Own ESI
Any ESI
19-24
-5.0*
-5.0*
-7.7*
-7.3*
25-34
-3.6*
-3.4*
-5.7*
-6.6*
35-44
-2.5*
-0.2
-2.2*
-3.2*
45-64
-2.4*
-0.4
-2.3*
-2.0*
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Young Adults' Reports of Access Problems in
Past Year by Insurance Status, 2005
Insured all year
Uninsured now
57%
60%
50%
45%
38%
40%
37%
35%
31%
30%
20%
18%
17%
12%
11%
10%
0%
Did not fill a
prescription
due to cost
Did not see
specialist
when needed
Skipped
medical test,
treatment, or
follow-up
Had medical Any of the four
problem, did
access
not see doctor
problems
or clinic
Source: The Commonwealth Fund Biennial Health Insurance Survey, 2005. Adapted from Collins, et al. 2007 and reprinted with permission from author.
Note: Refers to percent of young adults, ages 19-29, who reported experiencing the given access problem due to cost.
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Policies to Reach Young Adults
1.
Require employers to allow parents to have kids
up to age 24-26 as dependents.
• 1.6 million young adult uninsured children in families
with one or more parents with ESI
• Many states already do this, no evidence of major
effects
• Parents will likely have to pay much of the cost of
dependents
• Risk of adverse selection
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Policies to Reach Young Adults (cont.)
2.
Allow Medicaid/SCHIP to cover low income
adults
• Only 14% of uninsured young adults are currently
eligible
• Coverage of all those below poverty would reach 4.6
million of the 10.3 million uninsured young adults,
assuming 100% participation; will also have adverse
selection; crowd-out effects will be low because only
21% have ESI whereas 47% are uninsured (2006)
• Coverage of those between 100%-200% FPL would
reach another 3.2 million; crowd-out rates will be
higher (39% have ESI and 41% are uninsured)
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Policies to Reach Young Adults (cont.)
3.
Require coverage of college students
• Would cover 1.9 million uninsured young adults
• Most (75%) uninsured young adults are not
students; non students have a much greater
likelihood of being uninsured. (39.3% vs 19.2%)
• May be necessary with state or national health
reform
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Candidates Proposals and Young Adults
• Tax Policies
– Tax credit would cover a high share of costs of young
adult policy, particularly if healthy and in low cost
state
– Tax deductions (e.g. Bush) would be less helpful
because most uninsured young adults are low
income
• Medicaid Expansion, Income Related Subsidies
– Would provide subsidies to high share of young adult
uninsured
– Many would not enroll, despite subsidies, in voluntary
system; young and healthy are most likely to remain
uninsured
– Lack of waiting periods in Medicaid will exacerbate
adverse selection
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Candidates Proposals and Young Adults
(cont.)
• Insurance Reforms
– Guaranteed issue and modified community rating can
increase costs of insurance, particularly in voluntary
system; these reforms will adversely affect young
adults; even modified community rating will increase
costs more than experience rating.
• Individual Mandate
– Would require young adults to be covered; they would
pay more for coverage than pre-reform
– Many who would be mandated would receive financial
assistance
– What should their responsibilities be for support of
older Americans, in exchange for guarantee of
coverage later in life or in case of unexpected events?
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