1. Young, Uninsured and In Debt:
THE COMMONWEALTH
FUND
Young, Uninsured and In Debt:
Why Young Adults Lack Health Insurance and How the Affordable Care Act is Helping
Findings from the Commonwealth Fund Health Insurance Tracking Survey of Young Adults, 2011
Sara R. Collins, Ph.D.
Vice President, Affordable Health Insurance
The Commonwealth Fund
Media Teleconference
June 7, 2012

2. Exhibit 1. Study Methodology
Commonwealth Fund Health Insurance Tracking Survey of Young Adults, 2011
Study includes a nationally representative sample of 1,863 adults, ages 19 to 29
Sample was drawn from KnowledgePanel® – a probability-based panel that is representative of U.S. population.
Panel includes cell-phone only and low-income households that are typically difficult to reach using traditional telephone surveys and random digit dialing (RDD) sampling
Respondents completed online questionnaire in English or Spanish, November 4 through November 24, 2011
Overall margin of sampling error of +/- 3percentage points at 95% confidence level
Conducted by Knowledge Networks

3. Exhibit 2. Summary of Main Findings
Millions of Young Adults Covered on Parents’ Policies
The Affordable Care Act requires all health plans with dependent coverage to insure children to age 26.
In Nov. 2011, 13.7 million young adults ages said they had stayed on or joined parents’ plans over the last year.
Roughly 6.6 million likely would not have been eligible prior to the law.
But Millions More Report Gaps in their Health Insurance
18 million young adults (39%) age had a gap in coverage in 2011.
Young adults with low and moderate incomes were most at risk.
Young Adults Are Beginning Their Working Lives Unable To Get Needed Care and Burdened by Medical Debt
18.9 million young adults (41%) delayed needed care due to cost
16.8 million (36%) had problems paying medical bills, carrying medical debt
12 million made significant financial tradeoffs due to medical bills, debt
The Affordable Care Act: 2014 Provisions
New affordable coverage options slated for 2014 under the law will provide near universal coverage and cost protection for young adults
Findings suggest that young adults are likely to comply with the law’s coverage requirement and enroll in affordable health plans.

4. Exhibit 3. Nearly Two of Five Young Adults Spent Some Time Uninsured in the Past Year
Percent of adults ages 19–29 70 48 39 28 22
<$29,726
$29,726-<$55,875
$55,875-<$89,400
$89,400+
Notes: FPL refers to federal poverty level. Income levels are for a family of four in Numbers may not sum due to rounding.
Source: The Commonwealth Fund Health Insurance Tracking Survey of Young Adults, 2011.

5. Distribution of 10.4 million uninsured* adults ages 19–29
Exhibit 4. Nearly Three-Quarters of Uninsured Young Adults Had Incomes Under 250 Percent of Poverty
400%+ FPL
$89,400
14%
250%–399%
FPL
$55,875-<$89,400
15%
<133% FPL
$29,726
45%
133%–249% FPL
$29,726 -<$55,875
27%
Distribution of 10.4 million uninsured* adults ages 19–29
* Uninsured indicates uninsured at the time of the survey.
Notes: FPL refers to federal poverty level. Income levels are for a family of four in Numbers may not sum to 100 because of rounding.
Source: The Commonwealth Fund Health Insurance Tracking Survey of Young Adults, 2011.

6. Exhibit 5. Half of Young Adults Who Lost a Job with Health Benefits from November 2009 to November 2011 Became Uninsured
When you lost your job, what happened to your health insurance?
Went on
parent’s insurance
14%
Became uninsured
52%
Did not have insurance through job 68%
Had
insurance through job 31%
COBRA
16%
Went on spouse/
partner’s insurance 5%
Refused 1%
Found insurance through other source
13%
Adults ages 19–29 who lost a job in the past two years
Adults ages 19–29 who had insurance through job
Source: The Commonwealth Fund Health Insurance Tracking Survey of Young Adults, 2011.

7. Exhibit 6. Two of Five Young Adults Experienced a Cost-Related Problem Getting Needed Care
Percent of adults ages 19–29 who experienced the following access problems in the past year because of cost:
* Experienced any of the following because of cost: did not fill a prescription; skipped a recommended test, treatment, or follow-up; had a medical problem, did not visit a doctor or clinic; did not get needed specialist care.
Source: The Commonwealth Fund Health Insurance Tracking Survey of Young Adults, 2011.

8. Exhibit 7. More Than One-Third of Young Adults Experienced a Medical Bill Problem or Were Paying Off Medical Debt
Percent of adults ages 19–29 who experienced the following medical bill problems or accrued medical debt in the past year:
* Experienced any of the following in the past year: had problems paying medical bills; contacted by a collection agency for unpaid bills; had to change way of life to pay bills; is paying off medical bills/debt over time.
Source: The Commonwealth Fund Health Insurance Tracking Survey of Young Adults, 2011.

9. Uninsured during the year*
Exhibit 8. One-Quarter of Young Adults With Accrued Medical Debt Were Paying Off Medical Bills of $4,000 or More
Percent of adults ages 19–29 with accrued medical debt
How much are the medical bills that are being paid off over time?
Total
Insured all year
Uninsured during the year*
Less than $2,000
52%
55%
47%
$2,000 to less than $4,000 23 22
$4,000 to less than $8,000 10
$8,000 to less than $10,000 6 3
$10,000 or more 9 8 11
* Combines “Insured now, time uninsured in past year” and “Uninsured now”.
Source: The Commonwealth Fund Health Insurance Tracking Survey of Young Adults, 2011.

10. Exhibit 9. An Estimated 17 Million Young Adults Had Problems Paying Medical Bills Or Medical Debt in 2011; 70 Percent Reported Financial Consequences
Percent of adults ages 19–29 with medical bill problems or accrued medical debt in past year*
Percent of young adults with medical bill problems or debt reporting:
Percent
Millions
Used all of savings
43% 7
Asked parents/family for help
37% 6
Took on credit card debt
33%
Unable to meet other debt obligations such as loans/tuition payments
32% 5
Delayed education/career plans
31%
Unable to pay for basic necessities such as food, heat, or rent
28%
Any of the above
70% 12
* Experienced any of the following in the past year: had problems paying medical bills; contacted by a collection agency for unpaid bills; had to change way of life to pay bills; is paying off medical bills/debt over time.
Source: The Commonwealth Fund Health Insurance Tracking Survey of Young Adults, 2011.

11. Exhibit 10. Premium Tax Credits and Cost-Sharing Protections Under the Affordable Care Act
FPL
Income
Premium contribution as a share of income
Out-of-pocket limits
Actuarial value:
Silver plan
Ages 19 – 29 Uninsured during the year 2011
<133%
S: <$14,484
F: <$29,726
2% (or Medicaid)
S: $1,983
F: $3,967
94%
6.7 million
133%–149%
S: $16,335
F: $33,525
3.0%–4.0%
5.0 million
150%–199%
S: $21,780
F: $44,700
4.0%–6.3%
87%
200%–249%
S: $27,225
F: $55,875
6.3%–8.05%
S: $2,975
F: $5,950
73%
250%–299%
S: $32,670
F: $67,050
8.05%–9.5%
70%
2.9 million
300%–399%
S: $43,560
F: $89,400
9.5%
S: $3,967
F: $7,933
>400%
S: >$43,560
F: >$89,400 —
S: $5,950
F: $11,900
3.5 million
Four levels of cost-sharing: 1st tier (Bronze) actuarial value: 60%
2nd tier (Silver) actuarial value: 70%
3rd tier (Gold) actuarial value: 80%
4th tier (Platinum) actuarial value: 90%
Catastrophic policy with essential benefits package available to young adults and people who cannot find plan premium <8% of income
Notes: FPL refers to federal poverty level; levels are for Actuarial values are the average percent of medical costs covered by a health plan. Premium and cost-sharing credits are for silver plan.
Source:Commonwealth Fund Health Reform Resource Center: What’s in the Affordable Care Act? (PL and ),

12. Exhibit 11. Nearly Two-Thirds of Working Young Adults Ages Who Were Eligible For Employer Benefits Enrolled
Percent of workers ages 19–29*
Total
19-29
Ages
Availability and eligibility of employer insurance
Employer offers insurance
71%
64%
80%
Employee eligible for insurance 62 53 75
Take-up of employer insurance when offered and eligible 64 50 78
Current source of insurance coverage
Own employer
40%
26%
59%
Parent's employer 14 24
Spouse/partner/someone else's employer 9 6 13
Public program 7 4
Individual market or college or university 11 5
Military or other source 8 3
Uninsured 17
*Note: Workers include full-time and part-time workers who are not self-employed
Source: The Commonwealth Fund Health Insurance Tracking Survey of Young Adults, 2011.

13. Exhibit 12. Conclusion
The Affordable Care Act is Already Helping Millions of Young Adults Stay Insured
13.7 million year olds stayed on or joined parents’ health plans Nov Nov 2011
Roughly 6.6 million likely would not have able to do so prior to passage of the law.
But Millions More Young Adults Report Gaps in their Insurance Coverage
18 million young adults ages (39%) had a gap in coverage
70 percent of young adults with incomes under 133% FPL had a gap in coverage
Young Adults Are Starting Out in Life Burdened by Medical Debt
16.8 million young adults (36%) had problems with medical bills or medical debt
Of those: 7 million used up all their savings to pay their bills;
6 million took on credit card debt;
5 million were unable to meet other obligations like school loans or tuition;
5 million delayed education or career plans.
Among those paying off medical debt over time, 25 percent had $4,000 or more in debt
Affordable Care Act’s 2014 Provisions Will Provide Near Universal Coverage for Young Adults
18 million young adults with gaps in coverage and 16.8 million with medical bill problems will have new affordable insurance options with cost protections starting in 2014.
Evidence suggests that uninsured young adults will enroll in large numbers under the law: 64% of working young adults eligible for employer plans enrolled; millions joined parents’ policies