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What Health Care Reform Means for: ‘Young Invincibles’

Young people often forgo insurance coverage. Reform bills would no longer allow that, but what insurance they could get and how differ in each proposal.

Using results from a questionnaire we did with American Public Media’s Public Insight Network, we’re looking at how the proposed health care reforms will actually affect people facing common health care coverage situations. See our previous posts on what health care reform means for Medicaid Recipients, the uninsured, the underinsured, small businesses, those enrolled in Medicare programs, and the insured.

Neil Thurgood, 26

Location: Washington, D.C. Health Care Status: Insured through his wife Household Income: $65,000

His Story:

When Neil Thurgood graduated college in the fall of 2006, his health insurance lapsed while he looked for a job. At the time, he says, “I just kind of figured, I’m young and healthy and everything is cool,” so he didn’t worry when it took longer than planned to find a job. His wife eventually got one that offered insurance, but the premium was still too expensive for Thurgood to be covered.

That wasn’t a problem until January 2007, when Thurgood came down with what he now refers to as “some crazy renegade virus,” which landed him in the hospital with a fever of 105. A spinal tap and a day later, Thurgood was sent home with fuzzy understanding of why he was sick and a bill for about $6,000.

Nearly three years later things are looking up for Thurgood. He’s landed a job and is now insured through his wife’s coverage, which costs them $260 a month. But he’s still paying down his hospital debt.

“I feel bad having those kinds of obligations outstanding,” he said. “It’ll be paid when it’s paid.”

Thurgood is part of the group called “the Young Invincibles.” Young adults between 19 and 29 have the highest uninsured rate of any age group – they aren’t as worried about getting sick, they’re less likely to have jobs that will offer insurance, and they typically make less money than other age brackets so they can’t buy private insurance. In the last year, 47 percent of people between age 19 and 34 went without health insurance at some point, and one in three is uninsured now.

What Health Reform Means to Him:

A series of changes offered by both the House and Senate’s reform bills mean the “invincibles” will have more options for insurance – whether as a dependent on a parent’s insurance, Medicaid or as a purchase through an exchange — but one option that will no longer be available is skipping health coverage.

For relatively well-off young people, like Thurgood and his wife, health care reform will mean a new health insurance requirement, but not much help affording it.

Both health reform bills mandate that everyone has insurance, which means young adults wouldn’t have the option of staying uninsured unless they want to pay a fine. The House bill would fine them either 2.5 percent of their adjusted income ($1,624 for the Thurgoods) or the price of the lowest premium on the exchange, whichever is lower. The Senate bill would phase in a penalty over the next six years, eventually fining them $750 a person, or $1,500.

 As of now, coverage from a parent’s private plan or through a public program that covers children usually ends at age 19. But the both the bills extend the age that children can remain as dependents. The House extends it to the child’s 27th birthday, and the Senate extends it to the 26th.

For the poorest group of young people, Medicaid may be an option. The program does not currently cover young adults without a child or a disability, except for in 15 states that have waivers, but that’s about to change. Both the House and Senate bills would extend the population that they cover to include childless adults. (See our coverage of Medicaid and young adults.) The Senate bill also expands Medicaid to cover up to 133 percent of the federal poverty line (about $14,000 for a single person) starting in 2014, and the House bill expands it to 150 percent, or about $16,000, in 2013.

But at his current household income, Thurgood wouldn’t qualify for Medicaid.

If he decided he didn’t want to use his wife’s insurance, both bills would allow him to purchase health insurance through an exchange. However, it’s not clear how much exchanges will benefit healthy young people who earn too much to also qualify for government subsidies.

The House plan would create a national exchange, and the Senate plan would create state-based exchanges. The exchanges function like large pooling mechanisms, allowing people who would normally buy insurance through the individual market to buy into one of a menu of private group plans. The House bill also includes a public option – but that did not make it into the Senate version, and House leaders have indicated a willingness to drop it.

If he’s buying through the exchange, Thurgood could choose the Senate’s “young invincible” option, which offers people under 30 bare-bones coverage for a discount price — a possibility that would no longer be open to others who buy through the exchange, since levels of benefits will be set by Congress.

Lower-income young people who qualify for subsidies would probably skip the “invincible” option, because they could buy better insurance with government help, as the Congressional Budget Office has pointed out.

But the Thurgoods earn too much to qualify for subsidies, so buying coverage through the exchange may not help them much. The Thurgoods are above the income threshold to qualify for subsidies for premiums that are offered under each plan, which is 400 percent of the federal poverty line, or $58,280 for a family of two by 2009 standards. (Read our coverage of premium subsidies.)

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