Public Insurance Improves Young Adult Well-Being

Young adults aged 19 to 25 have the highest uninsured rate in the U.S. population compared to other age groups. This high uninsured rate is largely because many transition out of public programs or their parents’ employment plans, and have difficulty securing insurance during this time due to their employment patterns. The high uninsured rate among young adults is particularly concerning because health coverage for this group is tied to their ability to access care and use health care services.

Compared to their insured peers, uninsured young adults are more likely to delay or not receive needed medical care or fill prescriptions due to costs. They are also less likely to report being in excellent or very good health compared to their insured counterparts. When young adults do seek health care, about half struggle to pay medical bills or face outstanding debt. High uninsured rates can also negatively affect the economic well-being of young adults and their families—especially within low-income households.

Under the Affordable Care Act (ACA), Medicaid eligibility was expanded to include adults with incomes of $20,783.00 or less (138% of the federal poverty level). The major aims of this policy were to increase health coverage among low-income adults and to provide financial security to adults struggling to pay their medical debts. A few studies evaluated the effect of Medicaid expansion on the young adult population. No research, however, had specifically examined the policy’s effect on the health and non-health outcomes of childless low-income young adults—the young adults most likely to have benefitted from the policy.

Medicaid expansion is meeting a crucial health care need for low-income young adults.

To fill this research gap, I used data from 2010 to 2017 on childless young adults aged 19 to 25 who were U.S. citizens with total family income at or below 138% of the U.S. federal poverty level. This allowed me to compare the health insurance coverage, health status, health care access, health care use, and financial well-being of young adults residing in states that expanded Medicaid under the ACA to young adults residing in non-expansion states both before and after the policy change.

My results revealed that Medicaid expansion increased health insurance coverage in this age group.  The proportion of low-income young adults who could not afford needed mental health care or prescription medicine and who were worried about paying medical bills if they were sick or injured also decreased. Hispanics—the racial group with the highest uninsured rate—experienced greater increases in coverage. Further, the findings showed that Medicaid expansion resulted in low-income young adults switching from military and other types of government and state-sponsored health insurance coverage to Medicaid. This finding signals that Medicaid may be more effective in meeting the needs of low-income young adults than these programs.

Given that mental health disorders peak during young adulthood, gains in access to mental health care and needed prescriptions indicate that Medicaid expansion is meeting a crucial health care need for low-income young adults. Improvement in financial well-being is also substantial. Nevertheless, disparities in coverage rates among age, racial/ethnic identity, and income groups continue, particularly in non-expansion states. The results from my study show that providing health coverage improves the well-being of disadvantaged groups and provides crucial evidence for advocates in non-expansion states who are seeking to increase access to Medicaid.