Senator: Make Health Insurance for Young Adults Mandatory

Sen. Sherrod Brown (D-Ohio) has held several events with his constituents over summer break, including a roundtable discussion in Cambridge, Ohio, that I attended with administrators and health officials from various hospitals in southeastern Ohio. One of the first issues the senator raised was about requiring young people to purchase health insurance.

Brown said that young Americans admitted to trauma centers, being mostly uninsured, have been subsidized by insured Americans for years. Describing a conversation he had with a woman at a town hall, Brown said: "She said, 'But, you're making 25-year-olds get insurance.' We are. Every one of your hospitals, I would imagine, have brought in a young person who is hurt and has been in a motorcycle accident or something and has no insurance and that's really a tax on everyone else. Nationally, on average, it's about $1,000 per policy. Everybody's got to pay $1,000 more because you've got to take care of them. That's why we want to get younger, healthier people mandatory (insurance), insist that they all join, that way we get everybody in the system."

Richard Doan, chief executive officer at Barnesville Hospital, responded, "That is one of the primary reasons why you've got trauma centers now talking about not renewing their trauma status. (Young adults) can't pay for trauma care. Their bad debt is just huge and tremendous."

Though it is certainly significant, the size of the young adult burden on trauma centers may be up for debate. This study suggests that "complicating factors" causing skyrocketing trauma costs are much more likely in older individuals with exacerbating health problems or weak recovery systems, and this overview of Virginia hospitals reveals that a clear majority of trauma patients in that state are older. However, it is clear that covering young Americans is key to health care reform.

Consider these statistics: Americans between the ages of 18 and 29 are the most uninsured age group in the nation. More than 30 million young adults between the ages of 19 and 34 (46.8 percent) went without health insurance at some point during 2007 or 2008, and two-thirds of uninsured young adults between 19 and 29 went without necessary care and medical treatment in 2007. Young adult workers are half as likely to be covered by their employer as their colleagues.

For students, debt from loans and credit cards is rising every year. As more are forced to find jobs to try and pay for some of the debt, more companies are only offering unpaid internships due to weak economic conditions.

Sen. Brown has been largely sympathetic to the financial concerns of young Americans, specifically college students and graduates. In the past month he has introduced legislation that would help produce more community college graduates and announced another bill that would allow students to refinance private loans.

At the roundtable event, Brown made clear his belief that mandatory coverage for all young people will not increase their financial woes. "First of all, if they're in college, we're increasing Pell grants every year now," Brown told me. "The governor's frozen state tuition [my Cram coverage here and here] and that helps. Second, under this bill, you can stay under your parents' plan until you're 26. They can't throw you off until you're 26, so that helps them in that transition. Third, if you're low income and you don't have insurance, the federal government will pay most of it. The whole point is we want people in the system."

It is possible that keeping young adults on their parents' plans or providing Medicaid to those with low income will keep them from receiving a significant new bill each month? Individual coverage could be more costly given mandated "essential benefits" and required "community rating," which would make insurers charge the same rates to all members regardless of age or need of care. Some worry that the young, healthy insured will end up subsidizing the elderly and sick by paying the same amount for coverage (see Andrew Clark's breakdown of these issues in H.R. 3200 here).

Many states (26 in all) have laws allowing twentysomethings to stay on their parents' plan. Florida passed a law last year that allows students to remain on their parents' plan through age 30. The states essentially redefine the word "dependent" and require policyholders to pay an additional premium for adding an adult dependent. The Affordable Health Choices Act passed by the Senate's Health, Education, Labor and Pensions Committee mandates that private insurers cover young adults through their parents' plan until age 26. Linda Douglass, communications director in the administration's Office of Health Reform, told CNN that she thinks such language will make it to a House bill. Douglass said a policy built for young adults and focusing on prevention is in the works. For low-income young people, further Medicaid possibilities are in the works in Senate and House proposals as well. Currently, Medicaid only covers young adults in low-income families until they turn 19.

Many have likely noticed that town hall and debate participants thus far have skewed older. While there are big reform challenges for many groups of Americans, the importance of seeing the above proposals through should inspire many more young people to participate in health care debates and reform advocacy. As students return to campus, it is time to combat any disinterest or ignorance from uninsured peers not following these issues, especially as their numbers grow -- and before more are forced to learn the hard way.

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