July 23--Now that the U.S. Supreme Court has ruled that Congress can mandate individuals to carry health insurance or pay a penalty, starting in 2014, all eyes turn to Massachusetts.
That state has had a mandate since then-Gov. Mitt Romney signed it into law in 2006. Did people sign up for insurance when it took effect on July 1, 2007 -- or did they choose to pay the penalty?
And what about the group with the highest rates of no insurance, young adults in the 18-34 age range?
The results speak for themselves. Today, less than 2 percent of Massachusetts residents are uninsured -- and that has been consistent, in line with countries like Switzerland that have similar mandates. Very few choose to pay the penalty. People want insurance coverage.
And young adults? Most choose to get health insurance. Among young men, the rates of uninsured fell from 19 percent in 2006 to 9 percent in 2008. Among young women, from 7 percent to 3 percent.
But that change does not happen by itself. It took a lot of work in Massachusetts -- figuring out why people are uninsured, going to where they are and making it easy for them to sign up.
According to Joan Fallon, former Director of Public Education for the Massachusetts Health Connector, young adults want "cold, hard facts" about medical costs and penalties from people like themselves -- not people with insurance, not celebrities, not people with high incomes. Surprisingly, messages to mothers of young adults also are effective.
Messages like the accompanying bike ad were effective because they showed that eating right and being careful can't prevent every contingency -- and the consequences of being without insurance can be financially devastating.
Massachusetts also makes it extremely easy to compare plans -- like searching Travelocity (see www.mahealthconnector.org).
California is equally ambitious. Of 4.7 million in the 18-26 age group, 25.6 percent are uninsured. With the Affordable Care Act, the state hopes to reduce that to 6.4 percent within five years.
Of 4.6 million in the 27-34 age group, 26.7 percent are uninsured. California hopes to reduce that to 6.7 percent.
The tough thing is that young adults early in their careers move from job to job, and often end up in low-wage jobs that don't pay benefits. And in the current economic climate, it's difficult to find full-time jobs at all.
For those temporarily without a job, the new extension of Medi-Cal to childless adults will help. And those in the 19-25 age group who previously aged off their parents' coverage will be able to stay on.
But for many young adults cycling in and out of jobs, the health exchange opening January 2014 with sliding-scale cost based on income will be the important piece.
Price will be crucial. If enough healthy people sign up to balance sick people, prices will be affordable. Getting a full range of people covered is important for keeping premium costs affordable.
Just as Hollywood movies are judged by opening weekend box office, California's health exchange will be judged by Day One enrollment. So the state is planning aggressive pre-enrollment rollout for October 2013.
More than 2.5 million uninsured adult students attend community colleges. The state should go there and focus on social networks like Facebook, Twitter, LinkedIn, Google+ and YouTube. It should connect with young people who are waiting restaurant tables, or employed at firms with part-time workers.
The aim of the Affordable Care Act is to make sure that people are not priced out of coverage by life transitions. Young adults tend to be most affected by that and, thus, stand to be the biggest beneficiaries of the Affordable Care Act, if they enroll in insurance. That should reduce cost shifting and drive costs down for the rest of us, too.
(c)2012 The Sacramento Bee (Sacramento, Calif.)
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