July 24--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, let's look at the Massachusetts experience.

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% 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% in 2006 to 9% in 2008. Among young women, from 7% to 3%.

But that change does not happen by itself. It took a lot of work in Massachusetts. 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.

Massachusetts also makes it easy to compare plans -- like searching Travelocity (see www.mahealthconnector.org).

California shares those goals. Of 4.7 million in the 18-26 age group, 25.6% are uninsured. With the Affordable Care Act, the state hopes to reduce that to 6.4% within five years. Of 4.6 million in the 27-34 age group, 26.7% are uninsured. The goal is to reduce that to 6.7%.

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. 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.

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.

Tell us what you think. Comment on this editorial by going to fresnobee.com/opinion, then click on the editorial.

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