Column One:
Eye on Unmarried America

October 17, 2005



Getting health coverage for the young, single, and uninsured

by Thomas F. Coleman

Marital status and age are two factors which correlate closely to the lack of health insurance in the United States.

According to a report released last June by the National Center for Health Statistics, married people are twice as likely to have health coverage than people who have never married.  A spouse is three times as likely to have coverage than an unmarried partner.

Age also plays a major role in health insurance statistics.  From January through March of this year, nearly 30 percent of young adults between the ages of 18 and 24 had no health coverage.

It is hard to tell whether the lack of health care protection for young adults is attributable to their age or to their marital status since the large majority of people under 24 years of age have never married.

Unless or until a system of universal health care is adopted in the United States, those who advocate for more health coverage for more people will need to look closely at those who are young and single if they want to succeed in their mission.

Since most working-age adults receive health insurance through their employers, any plan to get more 18-24 year-olds covered will need to focus on expanding workplace benefits programs.  And since most employers are struggling to control the rising costs of health care benefits, a successful strategy to expand coverage will need to address the financial issue.

Since some of these young people are cohabiting with an unmarried partner, expanding a workplace benefits plan to include coverage for domestic partners will help get health coverage for a segment of this uninsured population. 

About 8,000 employers in the United States now provide domestic partner health benefits.  They report that, on average, a two percent increase in costs when these programs are implemented.

But the overwhelming majority of young adults are not cohabiting.  So what can be done to encourage employment-based health coverage for them?

Elected officials in two states -- Utah and New Mexico -- have enacted legislation to address this issue. 

Several years ago, Utah enacted a law which extended the age at which "dependent children" were entitled to health coverage through a parent's family health plan at work.  New Mexico enacted a similar law earlier this year.

Employers in these states may no longer drop coverage for a worker's child when the child turns 18.  Nor may they limit health insurance for those over 18 only if they are enrolled in college on a full-time basis.

In these two states, employers must allow workers to keep dependent children on the company's health plan until the child turns 26 years of age.

To keep employer's costs down, Utah and New Mexico require parents to reimburse employers for the extra cost associated with this extended coverage.  So there is no real financial detriment to the employers.

Although the parents must pay a monthly fee, the cost of coverage for their children through an employer-sponsored group plan is much less than they would have to pay for an individual policy for the adult child.

This type of a state mandate on employers has several beneficial effects.  More young adults are insured, parents save money through a group plan, and employers do not have to foot the bill.  Taxpayers may also benefit since fewer tax dollars will be spent on emergency room medical services to uninsured residents of the state.

The California Legislature passed a similar measure (AB 1698) only last month.  Unfortunately, Gov. Arnold Schwarzenegger decided to veto the bill because it required employers to pay some of the cost of the added coverage.

One wonders whether the Governor's advisors carefully considered the legislative reports which analyzed the beneficial fiscal effects of AB 1698.

A report issued by the California Assembly noted that, according to the California HealthCare Foundation, approximately  1.3 million Californians ages 18 to 24 are uninsured,  representing 20% of the state's 6.5 million uninsured.   It also cited data from the The Commonwealth Fund showing that young adults (ages 19 to 29) are one of the largest and fastest-growing segments of  the population without health insurance in the U. S.

Gov. Schwarzenegger is desperately seeking ways to reduce state expenditures.  Did he not read that section of the Assembly report which suggested that the state could save bundles of money if he had signed this bill.

According to the Assembly Appropriations Committee, AB 1698 would result in indeterminate savings to the extent individuals receive dependent coverage instead of  enrolling in the Medi-Cal program.  The Appropriations Committee estimates that if 5% of the 525,000 individuals ages 19-25  currently on Medi-Cal received dependent coverage through their  parent or guardian's employer as a result of this bill, instead of enrolling in Medi-Cal, full-year savings would be $55 million.

Perhaps advocates for reform and business leaders in California can find common ground next year and devise a bill which is closer to the models adopted in Utah and New Mexico.  If increased costs to employers were removed from the bill, Gov. Schwarzenegger's prime objection to AB 1698 would be eliminated, thereby increasing the chance that he would approve the new version.

California is already leading the nation in terms of domestic partner protections and benefits.  With a few fiscal adjustments, it could also become the largest state to provide more health coverage for the young, single, and uninsured.

Unmarried America 2005

Thomas F. Coleman, Executive Director of Unmarried America, is an attorney with 33 years of experience in singles' rights, family diversity, domestic partner benefits, and marital status discrimination.  Each week he adds a new commentary to Column One: Eye on Unmarried America. E-mail: Unmarried America is a nonprofit information service for unmarried employees, consumers, taxpayers, and voters.