Brighter access outlook tied to young adult coverage expansion

More people are reporting that they have a source of care -- and analysts say the Patient Protection and Affordable Care Act is the major reason why.

A provision that allowed those younger than 26 to remain as dependents on their parents' health plans has cut the uninsured rate for young adults, according to an analysis, released Dec. 14, 2011, of data gathered through the National Health Interview Survey. The analysis and survey were conducted by the Centers for Disease Control and Prevention's National Center for Health Statistics. It noted that, overall, the percentage of people, of any age, with a usual source of care went up from 85.1% in 2010 to 86.9% in the first six months of 2011.

"It's a pretty complicated puzzle, but we know that having health insurance makes a difference in whether people have a usual source of care and whether cost prevents them from accessing care," said Rachel Garfield, PhD, senior researcher at the Kaiser Family Foundation. "It's logical that these two are linked."

However, the increase doesn't mean that young adults are showing up in droves to see a physician -- at least not enough to reverse a decline in office visits noted by many surveys.

The percentage of the general population that was uninsured when completing the National Health Interview Survey dipped from 16%, or 48.6 million people in 2010, to 15.3%, or 46.6 million people in the first six months of 2011, according to CDC research.

Policy analysts believe this was primarily due to increases in insured rates among those 19 to 25 years old because the health reform law required most group health plans providing dependent coverage to allow adult children up to age 26 to stay or sign on to their parents' insurance as of Sept. 23, 2010. The percentage of those 19 to 25 years old who were uninsured at the time they were surveyed dipped from 33.9%, or 10 million, in 2010 to 28.8%, or 8.7 million, in the first six months of 2011. That age group represented 65% of the overall uninsured decline.

Most of this was driven by growth in private health insurance coverage. For instance, the percentage of this age group with private health insurance grew from 49.3% in the third quarter of 2010, when this aspect of reform was starting to take effect, to 58.4% in the second quarter of 2011. The proportion with public coverage went down from 15.8% in the third quarter of 2010 to 15.2% in the second quarter of 2011.

"It's always difficult to determine cause and effect, but certainly this part of the Affordable Care Act that enabled young people to stay on their parents' insurance until 26 almost certainly contributed in some way," said Dr. Virginia Hood, MPH, president of the American College of Physicians.

Analysts said uninsured and access-to-care rates also improved because of a recovering economy. The unemployment rate for people 20 to 24 years old was 14.4% in December 2011, down from the 15.2% reported for December 2010, according to Bureau of Labor Statistics data released Jan. 6. The overall unemployment rate was 8.5% in December 2011, down from 9.4% in December 2010.

Care delayed because of cost

The NCHS found that the percentage of people who delayed needed care because of cost held steady at 6.8% in the first six months of 2011. This number slowly rose from 4.5% in 1997 to 6.4% in 2008 and hit 6.8% in 2009 and 2010.

This flatlining is being correlated with improvements in coverage for young adults, because the uninsurance rate for other age groups went up. For example, the proportion of uninsured 26- to 35-year-olds increased from 26% in the first quarter of 2011 to 28.3% in the second quarter of that year.

"Having health insurance makes a difference for accessing all sorts of care, but particularly regular care," Garfield said. "Without coverage, people put off care until they're really, really sick. Having coverage usually means that people will come into care sooner."

But young adults are not traditionally heavy users of medical services, and analysts said it's too soon to say that the decline in visits to physician offices, primarily because of the recession, is over.

Various surveys have reported declining physician office visit totals, including Kaiser Family Foundation research published Nov. 15, 2011. It indicated that visits to physicians by patients with insurance declined 17% over two years, from 156 million in the second quarter of 2009 to 129 million in the second quarter of 2011. Analysts have said that insured patients often put off visits because they are paying more out of pocket for premiums and deductibles, straining already-tight finances.

"People are just struggling at all levels to deal with the cost of everything these days," said Dr. Hood, professor of medicine at the University of Vermont.

Other surveys have suggested that the decline in health care utilization may be slowing. For instance, the Thomson Reuters Healthcare Spending Index for Private Insurance released Nov. 29, 2011, reported that expenditures on physician services increased 3.5% in the second quarter of 2011 over the same quarter in 2010. The amount spent on physician services went up 1% from the first quarter of 2011.

But a Fitch Ratings report issued Dec. 7, 2011, suggested that the health industry as a whole will face significant challenges in 2012. The company expected growth in this sector of the economy, but this primarily would be driven by new product launches and fulfilling demand built up during the 2007-09 recession.

"Hospitals and other health care service providers in the U.S. will continue to be among the most pressured by the unfavorable economic conditions. ... Growth in less-profitable payer types, such as Medicaid and self-pay, will contribute disproportionately to organic growth," according to Fitch.