Sunday, June 20, 2010

Guest Blog: Two steps forward for America's health

Danielle Ofri, MD, PhD is the author of three books about her experiences as a general internist at NYU School of Medicine and serves as editor-in-chief of the Bellevue Literary Review. The following post originally appeared on her blog on May 27, 2010.



The fine print of the 2010 Health Care Reform bill is still being analyzed. Shortcomings and limitations are being uncovered. But a new report from the Commonwealth Fund showed that there will be immense and immediate gains for young adults.

Most young adults “fall off” of their parents’ health insurance plans once they complete their education (graduating from college or high school). Many get jobs without benefits. Many lose public health benefits like Medicaid when they turn 19. Most young adults can’t afford to purchase health insurance.

Nearly 14 million people aged 19-29 have no insurance. This represents fully a third of the uninsured of America. That’s an awful lot of people who are doing without medical care, paying exorbitant out-of-pocket costs, or relying on emergency rooms.

Starting in September of 2010, insurance companies will be required to allow children to stay on their parents’ plans until they turn 26. Beginning in 2014, Medicaid eligibility will be expanded to include all adults earning less that 133% of the poverty line.

These two provisions, plus the other key elements of the law—ban on lifetime limits and on discrimination based on health status—could serve to extend health insurance to nearly all young adults. The main group that will be left out will be undocumented immigrants. (Unfortunately, this group represents too much of a political lightening rod to allow any intelligent consideration of options.) Beyond that, it will be people who opt out of eligible plans, and choose to pay the fine instead.

What about that fine? The main premise of the reform act is that everyone needs to have insurance in order to eventually lower costs. For all the huffery and puffery about this mandate, two-thirds of all young people support this. As expected, young Democrats were stronger supporters than young Republicans. But what might be surprising is that young adults with lower incomes—those for whom this might be a hardship—were strongly in favor of this mandate. More so than those with upper incomes, for whom this would not be a big deal.

Many people predicted that the world would come to an end when this bill was passed, that there was some sort of nefarious government takeover in the works. Getting the young adults in our society—the next generation who will be contributing to our country—to have adequate health insurance? Doesn’t sound so nefarious to me.

I wonder how many of those opponents have college-age children. They are probably mighty eager to see September roll around.

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