national academy for state health policy © 2008 1 young and uninsured: closing the gap for the...
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National Academy for State Health Policy © 2008 1
Young and Uninsured:Closing the Gap for the
Invincibles and the Ineligible
AcademyHealth National Health Policy ConferenceFebruary 4, 2008
Alan Weil
Executive Director
National Academy for State Health Policy
202-903-0101
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Why I Don’t Have Many Slides
Eva Elise Weil, born Jan. 9, 2008
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Ages 30-35,12%
Under 18,
20%
Ages 36-49,23%
Ages 50-64,15%
Ages 24-29,16%
Ages 19-23, 14%
Uninsured Non-Elderly Adults, 2005
30% or 13.3 million of the uninsured are young adults
Source: S. Collins et al. “Rite of Passage? Why Young Adults Become Uninsured and How New Policies Can Help” Commonwealth Fund Issue Brief, August 2007. (Analysis of March 2006 CPS.)
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Uninsured Young Adults, 2005
<100% FPL, 41%
200% FPL, 28%
100-199% FPL, 31%
Source: S. Collins et al. “Rite of Passage? Why Young Adults Become Uninsured and How New Policies Can Help” Commonwealth Fund Issue Brief, August 2007. (Analysis of March 2006 CPS.)
More than 70% have incomes
below twice the federal
poverty level
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State Public Coverage Options
• Medicaid mandatory categories do not generally fit the young adult population– State options to cover certain 19 and 20 year olds
• Ribicoff• Medically Needy• Chafee/Foster Care Leavers
– Waivers• Childless adults• Family planning
– Buy-ins and state-funded programs
• SCHIP only covers children up to age 19
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States Taking up Medicaid Options for Certain
19-20 Year Olds
Implemented 3 options (3)
Implemented 2 options (10)
Implemented 1 option (18)
Did not implement any option (19)
NH MA
ME
NJ
CTRI
DE
VT
NY
DC
MD
NC
PA
VAWV
FL
GA
SC
KY
IN OH
MI
TN
MSAL
MO
IL
IA
MN
WI
LA
AROK
TX
KS
NE
ND
SD
HI
MT
WY
UT
CO
AK
AZ
NM
IDOR
WA
NV
CA
Sources: NASHP analysis based on Harriette B. Fox, et al., “The Public Health Insurance Cliff for Older Adolescents,” Incenter Strategies, April 2007; and American Public Human Services Association, “Medicaid Access for Youth Aging Out of Foster Care,” 2007.
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State Private Coverage Options
• Dependent Coverage Laws
• Underwriting and Rating Rules
• Limited benefit plans
• Individual Mandates/ College Student Mandates
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State Dependent Coverage Laws
NH MA
ME
NJ
CTRI
DE
VT
NY
DC
MD
NC
PA
VAWV
FL
GA
SC
KY
IN OH
MI
TN
MSAL
MO
IL
IA
MN
WI
LA
AROK
TX
KS
NE
ND
SD
HI
MT
WY
UT
CO
AK
AZ
NM
IDOR
WA
NV
CA
States that passed laws increasing the age of dependent coverage in 1994-2007 (19)
No program Source: NASHP, State Efforts to Extend Dependent Coverage for Young Adults; NCSL, The Changing Definition of ‘Dependent’: Who is Insured and for How Long?; and S.R. Collins et al. Rite of Passage? Why Young Americans Become Uninsured and How New Policies Can Help (The Commonwealth Fund, 2007).
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Do They View Themselves as Invincible?
Take-Up Rates of Own-Employer Insurance
82%73%
0%10%20%30%40%50%60%70%80%90%
Ages 19-29 Ages 30-64
Source: S. Collins et al. “Rite of Passage? Why Young Adults Become Uninsured and How New Policies Can Help” Commonwealth Fund Issue Brief, August 2007. (2005 Commonwealth Fund Biennial health Insurance Survey.)