Casting a shadow on the popular image of young adults in their twenties enjoying unlimited opportunity in a booming economy, a new report reveals that 12 million are vulnerable to the catastrophic expense of serious illness or injury because they do not have health insurance. Young adults ages 19-29 are twice as likely to be uninsured as children or older adults. Lack of insurance jeopardizes the health of young adults, especially those with low incomes. Many forgo preventive health care and say they would "wait as long as possible" to seek treatment when sick. "The current insurance system is breaking down for working families. As they reach their 19th birthday, young men and women find themselves on their own before they have achieved full independence or secured a job with health benefits," said Cathy Schoen, coauthor of the report and vice president at The Commonwealth Fund, which supported the study. "As a nation, we need to reexamine family insurance rules that don't provide for children over the age of 19 unless they are full-time students, and promote initiatives that encourage low-wage firms to offer employees insurance to protect our sons and daughters in these transitional years."
The study finds that family income and ability to attend school full-time are crucial factors for college-age adults ages 19 to 23. Those who can afford to attend school full-time typically remain covered under their parents' health plan—an opportunity that mainly benefits the sons and daughters of higher-income families. Among 19-to-23-year-olds from families with incomes in the top 20 percent, two-thirds are in school full-time and have health insurance, while only 7 percent are uninsured. In stark contrast, more than half of college-age adults with family incomes in the bottom 20 percent are uninsured; only 10 percent are insured and attending school full-time. Family insurance rules that provide coverage only to full-time students tend to leave most low-income 19-to-23-year-olds on their own.
Dispelling the myth that young adults do not need insurance because they are generally in good health, the report notes that many young adults suffer from chronic conditions such as asthma, are at risk for infections or injuries, or are in need of regular preventive care and counseling. Analysis of young adults' reports of their health care experiences reveals that lack of insurance often erects barriers to health care or puts young adults at risk for catastrophic medical expenses. Young adults without coverage are twice as likely as those with coverage not to get medical treatment when sick and twice as likely not to have seen a doctor in the year prior to the survey. Furthermore, they are more than twice as likely to wait "as long as possible" when ill before seeking medical attention (39% vs. 16%). Young adults with low incomes and no health insurance are at even greater risk. Three-quarters of the 12 million without coverage have incomes below 200 percent of the poverty level—roughly $17,000 for a single person. At these incomes, they have little cash available to spend on health care after meeting basic living expenses. Half (51%) of these low-income, uninsured young adults went without needed medical care during the year out of fear of costs. Two-thirds (67%) had problems paying medical bills. Three-quarters (73%) experienced one or both of these problems.
Workers ages 19 to 29 are less likely to have insurance sponsored by their own employer than older workers (42% vs. 62%). The report finds that characteristics of jobs available to these young adults are key to explaining the low rates insured. Those new to the workforce often start out in entry-level jobs that do not offer insurance or find themselves in waiting periods or temporary slots that render them ineligible for coverage. Younger adults are more likely than their older counterparts to work in jobs paying less than $7 per hour (33% vs. 14%) and more likely to change jobs during the year as they search for career opportunities (26% vs. 12%). This work profile raises the risk of working in a job without health benefits: three-fourths of young uninsured workers said they have no option of getting coverage through their jobs, either because their employer does not offer a health plan (39%) or because they are ineligible to participate in the plan (35%). "Failing to invest in our future by leaving young adults out of the health insurance system and denying them access to the high-quality care available in the United States creates a long-term cost to personal health and, ultimately, to the health of the nation's economy," said Kevin Quinn, an author of the report and staff member to The Commonwealth Fund Task Force on the Future of Health Insurance for Working Americans. The report was commissioned by The Commonwealth Fund Task Force on the Future of Health Insurance for Working Americans and written by Kevin Quinn and Louisa Buatti of Abt Associates, Inc., and Cathy Schoen of The Commonwealth Fund. The Task Force is a national, independent panel of leaders in business, insurance, public health, and state government established by The Commonwealth Fund to identify strategies to expand and improve health insurance coverage for America's working families. Reports issued by the Task Force can be found on the Fund's website, www.commonwealthfund.org. Methodology Most data in the report were drawn from one of two sources: the March 1999 Current Population Survey (CPS), which included approximately 50,000 households; or The Commonwealth Fund 1999 National Survey of Workers' Health Insurance, which was conducted by Princeton Survey Research Associates from January through May 1999 and consisted of 20-to-25-minute telephone interviews with a random, national sample of 5,002 adults ages 18 to 64, including 1,316 young adults ages 18 to 29. Results from the Commonwealth Fund survey refer to the 18-to-29 age group, while results from the CPS refer to the 19-to-29 age group.
