At the recent Weitzman Symposium, sponsored by Community Health Center, Inc, Aaron Smith, Senior Strategic Advisor & Co-Founder of Young Invincibles made a compelling presentation about engaging young people in health care. Young Invincibles is a non-profit organization that was founded in 2009 to make sure that young people’s voices were heard in the health reform debate. They have since become a major advocate for the enrollment of young adults into health insurance coverage.
Whether a sufficient number of young people would enroll in coverage was a major topic in the media in the past year. This is because the economics of insurance depends on the sharing of risk. Healthy individuals (typically young people) who pay premiums but do not use a lot of expensive health care services are needed to balance out the higher costs incurred by older individuals who tend to be sicker and utilize more care. The fear was that if an insufficient number of young people did not enroll, health care spending per person would be too high, resulting in increased premiums. This would then lead to even less young people being able to afford coverage, fewer of them signing up, raising premiums even higher, and so on, until the whole market collapsed in a downward death spiral.
So, what actually happened? While Connecticut-specific information is not out yet, we know that 28 percent of those who enrolled in coverage through the federal insurance marketplace were between the ages of 18 and 34. This was equivalent to the results of the first year of enrollment in Massachusetts when their state-based reform went into effect. It also seems to be in line with what insurance companies were expecting for year one enrollment. However, it will be important to improve on these results as the ACA moves forward.
Universal Health Care Foundation (UHCF) recently published a policy brief, Access to Coverage and Care: Targeting Implementation of the Affordable Care Act to Improve Health in Connecticut.The brief is based on data collected in the Connecticut Health Care Survey, a project funded by six health foundations in Connecticut, including UHCF. The brief gives an important baseline for what access to coverage and care looked like in Connecticut prior to full implementation of the ACA and makes policy recommendations for making ACA implementation as successful as possible in Connecticut.
The survey, conducted in 2012 and early 2013, found that younger adults, those aged 18-34, were almost two times more likely to be uninsured than adults 35 and older. The brief points out the importance of maximizing enrollment among this group and recommends that younger adults should be one of the populations targeted for ongoing outreach.
The Focus on Enrolling Young Adults Must Continue
So, while the doom predicted by opponents of the ACA did not occur, maintaining a focus on enrolling young adults will continue to be crucial to the success of the ACA. As Aaron Smith pointed out in his talk last week, enrollment of young adults will not stop now that the March 31 deadline is behind us. Young adults, are much more likely to experience one or more qualifying life events, allowing them to enroll at any time. For instance an estimated 4.2 million young people will turn 26 in 2014 and lose eligibility to be on a parent’s plan. Also, the average age for marriage is 26 and 28 for females and males, respectively. Young adults change jobs every two years and are twice as likely to move to another state. Also, many young adults have lower incomes and can enroll in Medicaid, which does not have an enrollment deadline.
Smith shared lessons learned from the work of Young Invincibles to enroll young people into coverage. For this ongoing effort, young people must be engaged where they are, including concerts and sporting events, fitness centers, community colleges, and, of course, on-line.
Further, being equipped with the right messages can be the difference-maker. Research suggests key messages include the importance of financial security, the fact that coverage for many young adults is free or very low cost and the benefit of starting early to maintain long term health.
Finally, in addition to continued outreach and enrollment efforts, it will be crucial to educate newly insured individuals about how to effectively use health insurance. This is the next big opportunity to promote a culture shift towards prevention, wellness and high value care from which the entire health system will benefit.