Young Adult's Perspectives on Being Uninsured and Implications for Health Reform

Currently, over 48 million people in the United States lack health insurance (DeNavas-Walt, Proctor, & Smith, 2012). Further, recent research suggests that nearly half of the adult population is either uninsured, experienced uninsurance at least once in the past year, or were not protected from extraordinary out-of-pocket medical costs associated with high deductible individual plans in 2012 (Collins, Robertson, Garber, & Doty, 2013). Close to 25% of those 18-24 and 28% of those 25-34 are uninsured, whereas only 14.7% of the overall population are uninsured (Cohen & Martinez, 2013). Review of the Literature It is well documented that a lower income is associated with not having health insurance (Schwartz & Schwartz, 2008) and it is costly to purchase health insurance in the open market (meaning the market outside of employer-sponsored coverage). However, even employed young adults face significant barriers to having health insurance. Young adults are more likely to be un- or under-employed and thus less likely to have employer-sponsored insurance or to afford the premiums associated with health insurance. Research suggests that close to one-quarter of young adults offered employer-sponsored insurance turn it down due to the expense. Young adults also tend to have lower wages even in full time jobs and face hurdles imposed by employers (e.g. having to work for a certain period of time before becoming eligible; Holahan & Keeney, 2008; Collins et al., 2013). A lack of a college education can compound the problem. Uninsured young adults are more than twice as likely as privately insured young adults to have no education beyond high school. Furthermore, people with less education are less likely to seek employment with large firms, which are more likely to provide health insurance as a benefit (Schwartz & Schwartz, 2008). Young adults are less likely to enroll in employer-sponsored insurance because of good health and the attitude that health insurance is not important. Compared to adults 27 years and older, adults 26 years and younger are less likely to believe that health insurance is necessary even after controlling for health status (Holahan & Keeney, 2008). These data strengthen the stereotype pointed out by Collins and colleagues that young adults consider themselves to be "invincible" (2012). Data from focus groups conducted by the Minnesota Department of Health (Krueger & Associates, 2002) support the sentiment that health insurance lacks value. The young adults participating in the focus groups felt health insurance was not worth what it costs and that they would pay more for insurance than they currently spend on health care. Additionally, it is difficult for young adults to access government-sponsored health programs, such as Medicaid. A majority of the young adults between the ages of 19-34 do not qualify for government health programs due to strict limitations on eligibility (Schwartz & Schwartz, 2008). According to Holahan and Kenny (2008), only 13% of uninsured young adults could be enrolled in Medicaid or other public coverage, which leaves them at the highest risk of not receiving needed medical attention (2008). In addition to eligibility, other barriers to using government-sponsored insurance include a lack of knowledge about eligibility, how, and where to apply; concerns about welfare eligibility; and barriers related to income documentation and the application process (Stuber & Bradley, 2005). Clearly government safety-net programs have a long way to go in addressing access issues facing the young adult population. Without insurance, young adults choose to skip recommended treatments, tests and follow up visits; avoid seeking necessary medical attention; forgo purchasing prescribed medications, or are paying off medical debt (Callahan & Cooper, 2005; Collins et al., 2012). Young adults are also more likely to lack a usual source of care, which can have long-term consequences for their health. …