Bringing young adults into coverage in Massachusetts

Although I’m upset at continued inflation of health insurance premiums in Massachusetts, I’m proud that the state has brought many more people into coverage since health reform was passed in 2006. We have the lowest rate of uninsurance in the US and have made strong progress in enrolling even hard-to-reach people. Two new reports sponsored by the Robert Wood Johnson Foundation assess the characteristics of the remaining uninsured and evaluate the role of special provisions in bringing young adults into coverage.

Massachusetts Health Reform in 2008: Who are the Remaining Uninsured Adults? identifies the groups that are more likely to lack coverage. They are:

  • Male, young, and single
  • Racial/ethnic minorities and non-citizens
  • Unable to speak English well or very well
  • Living in a household in which there was no adult able to speak English well or very well

These results aren’t terribly surprising, but they do underscore the need to focus on targeted interventions and outreach because broad-based messages and programs will have an uneven effect. These findings have implications for Massachusetts, but also for Federal efforts under PPACA. They are also likely to figure into debates on immigration policy.

As discussed in The Importance of Young Adult Provisions in Massachusetts’ Health Reform, Massachusetts did recognize at the outset that young adults would be hard to reach. Two provisions were included in health reform to encourage them to enroll:

  • Eligibility for dependent coverage was increased from age 19 to 26
  • A Young Adult Plan (YAP) was created that provided access to narrower benefits and higher cost sharing

According to the paper, the percentage of young adults lacking insurance coverage dropped by 61 percent over two years, whereas other comparison groups within Massachusetts (older adults, older minority adults and older childless adults) showed drops of 38 to 49 percent. In New York, by comparison, there was essentially no change in coverage levels within these groups during the same time period.

The authors also concluded that the special provisions for young adults in Massachusetts made a difference in that group’s enrollment.

PPACA contains similar young adult provisions to the Massachusetts law. It’s good to know there is some evidence that they will have the intended effect.

August 17, 2010

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