Increasing access to health insurance for young adults: An unheralded benefit of the ACA
Young adulthood marks a period of life transition that impacts the availability of health insurance. College and university students often lose health insurance upon graduation, young adults are more likely to have low-wage and entry-level positions that do not offer health benefits, and many young adults lack the financial resources required to independently purchase health insurance. As a result of these dynamics, young adults aged 18 to 29 have long been disproportionately uninsured, and uninsured for longer periods of time, when compared to those in other age groups.
Being able to stay on a parental health plan as a dependent provides young adults with an important mechanism to weather transitions and retain health insurance coverage. But before last September, when a young adult “aged out” of being able to stay on a parental plan varied by state and many states placed restrictions on which young adults could qualify as dependents. As a result of the Affordable Care Act (ACA), young adults across the country are now able to remain as a dependent on a parental plan, and therefore retain health insurance, until the age of 26.
But why is this important? After all, young adults are a relatively “healthy” population. Why should expanding health insurance options to this population be prioritized?
For many young women, the answer is contraception. Young adult women are at especially high risk for unintended pregnancy. Women in their 20s account for more than half (54 percent) of all unintended pregnancies in the US, and in 2001 there were more than 1.4 million unintended pregnancies among 18 to 24 year olds. Promoting access to and consistent and correct use of effective methods of contraception is critical for both reducing unintended pregnancy among this age cohort and fostering women’s reproductive autonomy.
And a woman’s health insurance status has a significant impact on her use of contraception. Studies have repeatedly shown that women with health insurance are more likely to use prescription contraceptives than uninsured women. That women who are uninsured often use less effective non-prescription methods (like condoms) or no contraception at all is hardly surprising; for many women paying out of pocket for the pill each month or incurring the upfront costs associated with getting an IUD is prohibitively expensive. A recent study by Ibis Reproductive Health in Massachusetts found that continued enrollment in a health plan that offered affordable contraceptive coverage was a key factor in shaping young women’s decisions about contraceptive use and method selection.
On September 23, 2010, a provision of the ACA quietly went into effect that offers young adults an important mechanism for obtaining or retaining health insurance. The ACA reformed the dependency statutes such that most young adults can now remain on a parent’s private health insurance plan until their 26th birthday. This includes young adults who are students as well as those who aren’t, young adults who are single or those who are married, and young adults who live with their parents and those who don’t. A young adult can be eligible as a dependent with respect to a parental health plan even if that same young adult isn’t considered a dependent for tax purposes. And the ACA only established a federal minimum; a number of individual states extend dependency coverage to young adults age 26 and older.
Of course, dependency statute reforms don’t impact all young adults and these reforms don’t necessarily translate into health insurance that is affordable or comprehensive. But the ACA marks an important step in meeting young adults’ health insurance needs in general and expanding access to contraception in particular. As a result of the ACA, as many as 2.12 million young adults will be newly covered by a parental plan by the end of 2011. However, in order for young adults to take full advantage of the dependency statute changes, we need to increase awareness among young adults and their parents about these reforms.
Increasing access to preventive health services is at the core of the ACA and young adults are among the many populations poised to benefit from reform. The one-year anniversary of the ACA represents an important moment, one that both allows us to recognize the gains we have made and inspires us to redouble our efforts to make affordable, high-quality, and comprehensive health care a reality for all.
Dr. Angel M. Foster is a Senior Associate at Ibis Reproductive Health.