An estimated 7.8 million of the 15 million young adults who were enrolled in a parents health plan last year likely would not have been eligible for this coverage without the Affordable Care Acts dependent coverage provision, according to a new Commonwealth Fund survey.
However, the survey also found that only 27% of young adults were aware of the state health insurance marketplaces that are launching Oct. 1. And millions of low-income young adults are at risk of remaining uninsured if the states they live in choose not to expand Medicaid.
The report, “Covering Young Adults Under the Affordable Care Act: The Importance of Outreach and Medicaid Expansion,” dispels the notion that young adults do not think they need health insurance, according to a Commonwealth Fund news release.
The survey of adults ages 19 to 29 found that when offered health insurance benefits through an employer, 67% took the coverage. For those who did not enroll in an employer health plan, the chief reasons given were that they were covered by a parent, spouse, or partner (54%) or that they could not afford the premiums (22%). Only 5% turned down coverage because they felt they did not need insurance.
“There is a stereotype that young adults believe theyre ‘invincible and dont want or need health insurance,” Sara Collins, the studys lead author and Commonwealth Fund vice president, said in the news release. “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.”
Stressing the importance of outreach and education to ensure people are aware of the reform laws benefits, the authors note that as more young adults and their families became aware of the provision allowing them to remain on their families insurance policies, uptake increased, from 13.7 million enrolled young adults in November 2011 to 15 million in March 2013.
According to the report, while the number of uninsured young adults dropped from 18.1 million in 2011 to 15.7 million in 2013, those who remained uninsured were overwhelmingly low- or middle-income. Of young adults who were uninsured for a time in 2013, 82% lived in low- or middle-income households and would be eligible for subsidized insurance through the marketplaces or through Medicaid. These young adults are at risk of remaining uninsured for two reasons: lack of awareness about the marketplaces or residence in a state that is not planning to expand Medicaid eligibility.
Young adults who would benefit most from the health insurance marketplaces — those without coverage and those from low- or middle-income households — are the least likely to be aware of them, according to the report. Only 19% of young adults who had been uninsured during the year and 18% of low-income young adults were aware of the marketplaces.
In addition, as many as 25 states may not expand Medicaid eligibility, potentially leaving millions of young adults without coverage. The poorest young adults in states that do not expand Medicaid will be especially at risk, according to the report, because those with incomes under 100% of the federal poverty level will be excluded from both Medicaid and subsidized private plans. According to the survey, nearly 30% of young adults who spent time uninsured during the year were in families with incomes under 100% of poverty.
The Commonwealth Fund health insurance tracking surveys of young adults were conducted by the online research firm Knowledge Networks GfK in 2011 and 2013, among a representative sample of young adults, defined for the survey as ages 19 to 29. Both survey samples were drawn from KnowledgePanel, a probability-based online panel that is representative of the U.S. population and includes cell phone-only and low-income households that typically are difficult to reach using traditional telephone surveys and random digit dialing sampling.
In 2011, 3,438 adults ages 19 to 29 were randomly sampled from this panel and invited by e-mail to complete an online questionnaire in either English or Spanish. The survey was completed by 1,863 respondents, yielding a 54% completion rate among sampled respondents. In 2013, 3,530 adults ages 19 to 29 were invited by e-mail to complete the 2013 online questionnaire; it was completed by 1,885 respondents, yielding a 53.4% completion rate. The 2013 sample includes 1,052 respondents who completed the survey in 2011, of whom 161 were excluded from this analysis because of their ages (30-31).