The mid-term congressional election is less than two months away and some observers wonder whether the event will be all about nothing.
One of the first provisions of federal health care reform _ allowing young adults to stay on their parents' health insurance until they turn 26 _ is expected to make a big dent in the number of uninsured young people this year.
The change will make it easier and cheaper for thousands of 20-somethings to obtain insurance _ even in states where other options have existed for several years.
Young adults like Casey Schick, 23, of Glen Rock, N.J., and Meghan Mullooley, 22, of Lyndhurst, N.J. _ who have part-time, entry-level, or unpaid jobs, if they have jobs at all _ have the lowest rates of insurance coverage of any age group.
More than 30 percent of young adults nationwide are without insurance. They earn less, on average, than those who are older, and have higher rates of unemployment. They account for about one-fifth of the nation's uninsured.
By expanding coverage to young adults until age 26, "over 1 million young adults can keep or get coverage at an affordable level," said Health and Human Services Secretary Kathleen Sebelius.
The expansion is expected to increase premiums for all by less than 1 percent, Sebelius said.
In states that have enacted a similar law, such as New Jersey, the impact will probably be less dramatic. But in most cases, the federal law will reduce the cost to parents to insure their grown children _ because they won't have to buy individual policies for them, for example _ and get those kids better coverage.
"If we do have insurance, it's often not very good insurance," said Aaron Smith, 28, who co-founded Young Invincibles, an advocacy group for young adults in the reform debate, last year. "You hear of kids going to the ER and ending up with hundreds of thousands of dollars of bills."
Smith graduated from Georgetown University Law School last month. As he heard stories of young people around the country, he found that work and life decisions were often influenced by the availability of health insurance.
Across the country, some plans force young people off their parents' plans when they turn a certain age, usually from 19 to 23. Or coverage may continue through the college years, but end abruptly upon graduation. College students covered by student policies can find their coverage runs out before their needs do; unluckiest are those who develop cancer or another serious illness and subsequently can't get affordable coverage. Fifteen percent of people ages 18 to 34 suffer chronic illnesses, including 180,000 young adults in New Jersey with asthma, and more than 40,000 with diabetes.
One young woman who graduated from Montclair State University last month has had eight operations to correct malformations on the side of her face caused by a rare congenital condition, diagnosed in her teens. The 22-year-old Little Falls, N.J., resident has a part-time job while she looks for full-time work, and is on her parents' health plan. She asked that her name not be used.
To her, the passage of health care reform was a tremendous relief.
"If I don't have consistent surgeries, it will grow into something physically deforming," she said of her condition, arteriovenous malformation. Abnormal connections between blood vessels are found on her cheek, temple and neck. She visits a specialist a few times a year for monitoring.
The young-adult extension is one of the most popular aspects of the Affordable Care Act reforms that squeaked through Congress in March. "That's the biggest thing that people talk about," when he meets constituents around his district, said U.S. Rep. Frank Pallone Jr., D-N.J., at a health-reform conference recently. The Obama administration, hoping to earn some early public support for health reform, has encouraged insurers to move up the rollout date so this year's graduates won't fall off insurance rolls.
"It's clear they want to include as many (young adults) as possible," said Joel Cantor, director of the center for state health policy at Rutgers University.
Dependents are eligible even if they're married or economically independent. They need not be students, nor live in the same state as their parents.
"We think it's good for the whole system to get more healthy people to get coverage," said Larry Altman, vice president of the state's largest insurer, Horizon Blue Cross Blue Shield. "We're supportive of this."
That view is not universal, however. "What I worry about is the cost impact," said Christine Stearns, of the New Jersey Business and Industry Association.
Employers could find ways to pass the cost to their workers. "The more the cost of family coverage grows, employers will have to look carefully at how they subsidize it," she said.
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New Jersey already has a so-called slacker mandate that enrolls about 13,500 young adults. Although it has the highest age limit _ 31 _ of any dependent-coverage mandate nationally, the pool of potential enrollees has been restricted by regulation to unmarried residents of New Jersey (or full-time students elsewhere) who have no other insurance options. And the mandate applies only to state-regulated plans, which cover about one-third of insured New Jerseyans.
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Many insurance carriers have responded to the White House invitation for an early rollout, though details vary, said Ward Sanders, executive director of the New Jersey Association of Health Plans.
On June 1, Aetna was scheduled to begin allowing young adults to stay on their parents' coverage in the individual and small-group market, said Mohit Ghose, an Aetna vice president. Those who use Aetna as an insurance administrator also were given the opportunity to make the switch on June 1, he said.
Horizon implemented it on May 1 for its insured plans. "If they're on their parent's account now, they can stay on it," said Altman. "We're doing it so they don't have a gap in coverage." Other plans, for which Horizon is the administrator, can choose to wait or implement it early.
Some companies advanced the implementation date only for those who would fall out of coverage this year. But others are allowing young people who've already been dropped _ and don't have other insurance _ to re-enroll.
The new law requires insurance carriers to offer extended coverage on or after Sept. 23, whenever the parent's plan is renewed.
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At Scott Kay Inc., a Teaneck, N.J., jewelry manufacturer that insures about 100 people, the company's health plan renews on Oct. 1, said Jeffrey Simon, its chief financial officer. One employee asked if his 24-year-old daughter could be brought back onto his policy while she changed jobs this summer, but the timing was wrong. Another wondered if his son, who graduated from college this month, would be better off insured through the federal extension, or through the state law that mandates dependent coverage through age 31.
"It becomes an issue of whether they have other children on the plan or not," said Jeffrey Ingalls, a principal of Stratford Financial Group, the insurance broker for Scott Kay. If the employee already pays for family coverage, the addition of the older child won't increase his premium. But if the employee has to switch from single or couples coverage to family coverage, that will increase premiums significantly.
For parents, the reaction to the change in insurance rules is mostly relief _ mixed with confusion about the details.
"We're all talking about it," Jeanne Mullooley, Meghan's mother and a Catholic school teacher, said of her colleagues. She feels fortunate that Meghan hasn't been sick since her coverage lapsed last August, three months after graduating from Georgetown.
Meghan has a part-time job, but isn't eligible for coverage through it. "She's not concerned at all," Mullooley said. "I'm sick (about it)."
Patty Horton, Casey Schick's mother, says she realized the importance of health insurance when another of her children survived a serious illness. "Life can change in a minute," she said. Casey, a varsity soccer player at Western New England College, has been an unpaid coaching assistant while substitute teaching.
As an athlete, "there is always the possibility of injury, not to mention illness," says his mother. His coverage also ended after he graduated.
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