HRMS Issue Brief 23

The percentage of young adults ages 18 to 34 in Texas without health insurance has dropped by 35 percent since the Affordable Care Act (ACA) went into effect, according to a new report released today by Rice University’s Baker Institute for Public Policy and the Episcopal Health Foundation.

The report is the 23rd in a series on the implementation of the Affordable Care Act in Texas co-authored by Vivan Ho and Elena Marks. The Health Reform Monitoring Survey (HRMS) is a quarterly survey of adults ages 18-64 that began in 2013. The HRMS is designed to provide timely information on implementation issues under the ACA and to document changes in health insurance coverage and related health outcomes. The Baker Institute and the Episcopal Health Foundation are partnering to fund and report on key factors about Texans obtained from an expanded, representative sample of Texas residents (HRMS-Texas). The HRMS was developed by the Urban Institute, conducted by GfK and jointly funded by the Robert Wood Johnson Foundation, the Ford Foundation and the Urban Institute. The analyses and conclusions based on HRMS-Texas are those of the authors and do not represent the view of the Urban Institute, the Robert Wood Johnson Foundation or the Ford Foundation.

Click the links below to view the reports to date:

• "Rate of uninsured young adults drops by more than one-third in Texas" (released Aug. 23, 2016)
• "The Impact of the Affordable Care Act on Adult Hispanics in Texas" (released July 14, 2016)
• "Changes in Rates and Characteristics of the Uninsured Among Texans ages 18-64 from 2013 to 2016" (released May 31, 2016)
• "Insured Texans lack clear understanding of their health insurance plans" (released March 24, 2016)
• "Twenty-five percent of Texans say they don't understand basic health insurance terms" (released March 8, 2016)
• "Most uninsured Texans say cost of health insurance too high" (released Jan. 28, 2016)
• "Affordability of Health Services among Non-Elderly Texas Adults" (released Jan. 7, 2016)
• "Characteristics and Changes in Rates of the Uninsured in Texas and the United States as of September 2015" (released Dec. 17, 2015)
• "The Impact of the Affordable Care Act on Texas Workers" (released Oct. 6, 2015)
• "Comparison of Affordability and Utilization of Health Care Services by Insured and Uninsured Adult Texans" (released Aug. 20, 2015)
• "Characteristics of Uninsured Texans as of March 2015" (released July 30, 2015)
• "Change in Insurance Status of Adult Texans By Demographic Group as of March 2015" (released June 2, 2015)
• "Effects of the Affordable Care Act on Health Insurance Coverage in Texas as of March 2015" (released April 30, 2015)
• "Marketplace Plans: Premiums, Network Size and Market Competition" (released Nov. 10, 2014)
• "Preparing for the Second Marketplace Open Enrollment Period in Texas" (released Oct. 16, 2014)
• "Affordability of Marketplace Plans in the Largest Metropolitan Areas of Texas" (released Sept. 23, 2014)
• "Insurance status of adult Texans and characteristics of the uninsured as of June 2014" (released Sept. 3, 2014)
• "Affordability of Marketplace Plans for the Marketplace Target Population" (released July 8, 2014)
• "The Experience of Texans with healthcare.gov" (released June 11, 2014)
• "The Affordable Care Act and Hispanics in Texas" (released May 9, 2014)
• "Early Effects of the Affordable Care Act on Health Insurance Coverage in Texas for 2014" (released April 14, 2014)
• "The Affordable Care Act and Texas' 'Young Invincibles'" (released March 31, 2014)
• "Were Texans Satisfied with the Cost of Health Care and Health Insurance Prior to the Affordable Care Act?" (released Feb. 10, 2014)

Rate of uninsured young adults drops by more than one-third in Texas

The percentage of young adults ages 18 to 34 in Texas without health insurance has dropped by 35 percent since the Affordable Care Act (ACA) went into effect, according to a new report released today by Rice University’s Baker Institute for Public Policy and the Episcopal Health Foundation.

The report found the uninsured rate among young adults in Texas dropped from 33 percent in September 2013 to 21 percent in March 2016. This age group is often called “young invincibles” by the health insurance industry because they don’t always purchase health insurance since they believe they are too healthy to warrant the cost.

Prior to the ACA going into effect, young invincibles had higher uninsured rates than older Texans. However, the report found this group of young Texans now has a lower uninsured rate than Texans ages 36 to 49.

“We found a significant increase in young adults getting health insurance through employer-sponsored health plans,” said Vivian Ho, the chair in health economics at Rice’s Baker Institute and director of the institute’s Center for Health and Biosciences, a professor of economics at Rice and a professor of medicine at Baylor College of Medicine. “The ability of many young invincibles to remain on their parents’ plans likely explains a substantial part of the drop in the uninsured.”

Under the ACA, children up to age 26 can remain on their parents' health plan.

Researchers say the ACA provision requiring large employers to make affordable health insurance available to employees and the strong Texas economy may also have contributed to the rising rates of health coverage for young invincibles as well as Texans overall.

The report discovered Hispanics and young adults making less than $16,000 a year were the most likely young invincibles in Texas to remain uninsured. Researchers found more than one-third of young Hispanics and 56 percent of low-income young adults in Texans still do not have health insurance.

“For those young adults with the lowest incomes, the ACA coverage solution was an expanded Medicaid program,” said Elena Marks, EHF’s president and CEO and a nonresident health policy fellow at the Baker Institute. “Because Texas has not yet opted to use the federal Medicaid dollars to cover these individuals, it’s likely they’ll remain uninsured.”

The participation of young invincibles in the ACA health insurance marketplace is important to its long-term success, the report said. Researchers said the lack of sufficient young invincibles and other healthier adults enrolled in ACA marketplace plans is cited by some as a factor in anticipated increases in 2017 premiums and the withdrawal of large insurance carriers from some state health insurance marketplaces.

“The composition of risk pools -- including a mix of healthier and less healthy participants -- is vital for the long-term sustainability of the ACA health insurance marketplace,” Ho said.

Marks said outreach and enrollment organizations should develop new approaches to reach young adults in Texas, especially those who paid the escalating tax penalty fee for being uninsured.

“Another promising strategy is to encourage enrollment groups to assist young adults who are aging out of Medicaid and CHIP (Children's Health Insurance Program) and help transition them to ACA marketplace insurance plans or other coverage,” Marks said. “Youth-friendly e-outreach during the upcoming open enrollment period may also be effective.”

The report is the 23rd in a series on the implementation of the Affordable Care Act in Texas co-authored by Marks and Ho.