1. National Academy for State Health Policy © 2008 1 Young and Uninsured: Closing the Gap for the Invincibles and the Ineligible AcademyHealth National Health Policy Conference February 4, 2008 Alan Weil Executive Director National Academy for State Health Policy aweil@nashp.org 202-903-0101

2. National Academy for State Health Policy © 2008 2 Why I Dont Have Many Slides Eva Elise Weil, born Jan. 9, 2008

3. National Academy for State Health Policy © 2008 3 Ages 30-35, 12% Under 18, 20% Ages 36-49, 23% Ages 50-64, 15% Ages 24-29, 16% Ages 19-23, 14% Uninsured Non-Elderly Adults, 2005 30% or 13.3 million of the uninsured are young adults Source: S. Collins et al. Rite of Passage? Why Young Adults Become Uninsured and How New Policies Can Help Commonwealth Fund Issue Brief, August 2007. (Analysis of March 2006 CPS.)

4. National Academy for State Health Policy © 2008 4 Uninsured Young Adults, 2005 <100% FPL, 41% 200% FPL, 28% 100- 199% FPL, 31% Source: S. Collins et al. Rite of Passage? Why Young Adults Become Uninsured and How New Policies Can Help Commonwealth Fund Issue Brief, August 2007. (Analysis of March 2006 CPS.) More than 70% have incomes below twice the federal poverty level

5. National Academy for State Health Policy © 2008 5 State Public Coverage Options Medicaid mandatory categories do not generally fit the young adult population –State options to cover certain 19 and 20 year olds Ribicoff Medically Needy Chafee/Foster Care Leavers –Waivers Childless adults Family planning –Buy-ins and state-funded programs SCHIP only covers children up to age 19

6. National Academy for State Health Policy © 2008 6 States Taking up Medicaid Options for Certain 19-20 Year Olds Implemented 3 options (3) Implemented 2 options (10) Implemented 1 option (18) Did not implement any option (19) Sources: NASHP analysis based on Harriette B. Fox, et al., The Public Health Insurance Cliff for Older Adolescents, Incenter Strategies, April 2007; and American Public Human Services Association, Medicaid Access for Youth Aging Out of Foster Care, 2007.

7. National Academy for State Health Policy © 2008 7 State Private Coverage Options Dependent Coverage Laws Underwriting and Rating Rules Limited benefit plans Individual Mandates/ College Student Mandates

8. National Academy for State Health Policy © 2008 8 State Dependent Coverage Laws Source: NASHP, State Efforts to Extend Dependent Coverage for Young Adults; NCSL, The Changing Definition of Dependent: Who is Insured and for How Long?; and S.R. Collins et al. Rite of Passage? Why Young Americans Become Uninsured and How New Policies Can Help (The Commonwealth Fund, 2007).

9. National Academy for State Health Policy © 2008 9 Do They View Themselves as Invincible? Source: S. Collins et al. Rite of Passage? Why Young Adults Become Uninsured and How New Policies Can Help Commonwealth Fund Issue Brief, August 2007. (2005 Commonwealth Fund Biennial health Insurance Survey.)