Robert Hiltonsmith is a Policy Analyst in the Economic Opportunity Program at Demos.
During the debate on health care that preceded the passage of the Affordable Care Act (ACA), one of the most-discussed topics was the heath care coverage status of young Americans. At the time, young people had the highest uninsurance rate of any age group: According to the CPS data Demos and Young Invincibles used for our State of Young America report, the uninsurance rate for 18-24 year-olds was over 30% in 2009, while the rate for adults 35 and older was less than half of that, at 13%. One of the popular explanations for young adults’ much higher uninsurance rate was that young people felt “invincible” and thus chose to be uninsured, believing they did not need health insurance because they were young and healthy.
However, events since the passage of the ACA seemingly contradict that narrative. Since the provision of the ACA allowing young people to remain on their parents’ insurance plans until age 26 (three years longer than they could before its passage) took effect in September 2010, over 2.5 million more young adults now have insurance than did nearly a year and half ago, according to the Department of Health and Human Services. This is in contrast to a decline in the percentage of slightly older young adults (ages 26-35) with insurance.
So, what caused this dramatic rise in the health insurance coverage rate of 18-25 year-olds? One explanation is that young people don’t in fact feel invincible, that they do want health insurance, and that some other factor, such as price or unavailability, was the primary reason they were uninsured. An alternative explanation, however, could be that young people didn’t really want insurance all that much, but pressure from their parents to get coverage combined with the relatively low cost of keeping young people on their parents’ plans was the driver behind the drop in their uninsurance rates since the dependent care coverage provision of the ACA took effect.
Which explanation is the correct one? Data from the survey we conducted as part of the State of Young America report strongly suggests that the first explanation is the biggest driver of the observed rise in coverage; in other words, that young people weren’t remaining uninsured by choice. In our survey, a national-representative poll of 872 adults ages 18-34, we asked uninsured young adults the following: “Which reason BEST explains why you do not have health insurance?” The results, reproduced in the figure below, give a clear answer.
52% of all young adults surveyed said that they didn’t have insurance because they couldn’t afford to. Combined with the 15% who reported being uninsured because their employer didn’t offer it and the 4% whom the insurance companies refused to insure, a total of 71% of young people were arguably “involuntarily” uninsured. In contrast, just 17% reported that they chose not to have insurance. The results for young women were particularly stark: 76% were involuntarily uninsured while just 11% reported remaining uninsured by choice.
What do you think? Do you believe that the still-high uninsurance rates of young adults are because young people choose to remain uninsured, or that most young people would purchase insurance if offered a reasonably-priced plan?
Photo Credit: Leader Nancy Pelosi