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“If every single, you know, resident of the state is required to have insurance to live here… we’ll have a much better, like healthier society and everyone will be able to have access to what they need… I think that it would be great if everyone could have health insurance because then, you know, we would definitely have some better lives.” 

 —Natasha, a college student, speaking about Massachusetts health care reform

In the summer and fall of 2009, Ibis Reproductive Health led 11 focus group discussions across Massachusetts to explore the experiences with sexual and reproductive health care of young adults in the wake of health reform in the Commonwealth.  Like Natasha, the majority of participants – 89 young women and men aged 18 to 26 – viewed health care reform as an important and positive effort because it furthers social justice goals and provides societal benefits with respect to promoting preventive care. Donald, echoing many young adults, recognized the importance of being insured: “In these days and times, you need health insurance.”

But the story got more complicated as we got into the discussions. As we probed more deeply, we learned that for many participants, health care reform was synonymous with the “individual mandate” to be insured. Few participants were able to describe other components of reform, such as the creation of young adult-targeted plans, the expansion of MassHealth (Medicaid), the creation of new subsidized insurance programs, or the changes in the dependency statutes, which allow young adults to be on their parents' insurance until age 26.

In fact, the single greatest concern expressed about health care reform involved the affordability of health insurance. Ashley spoke for many when she argued that Massachusetts should be “focusing on mandating health care but also making it feasible for people.” Yet few participants were aware of how reforms were designed to increase access to affordable health coverage, including provisions that might help them as individuals. 

Although the majority of participants did not see themselves as having personally benefited from health care reform (even when they were taking advantage of lesser-known provisions), those who had personal experience with subsidized insurance programs described how affordable health insurance had changed their lives. For some, this meant better access to needed treatments, while for others, it was a connection to preventive care and a sense of security. Deann described, “I don’t really need to go to the doctor or anything, but I feel like with this reform, health reform, now I have this insurance for the young adult. I feel like I’m healthier…so I think that’s really important.

These young adults know that health insurance is essential and support reforms that expand access to health care services. We must build on their faith that the Affordable Care Act, like Massachusetts’s reforms, can contribute to a just society by demonstrating that health care reform can provide affordable, high-quality coverage that is within financial reach of everyone.

Danielle Bessett, Ph.D., is Assistant Professor of Sociology at the University of Cincinnati.  Ibis Reproductive Health led the formative research component for an initiative to prevent unplanned pregnancy and promote sexual health in the Commonwealth called Reproductive Empowerment and Decision Making for Young Adults (REaDY).

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