Young adult's perspectives on being uninsured and implications for health reform

Young adults between the ages of 18-34 are most likely to lack health insurance in the United States. The Affordable Care Act (ACA), a federal statute signed into law in 2010, contains provisions specific to increasing access to health insurance for young adults including the provision that persons under 26 can stay on their parents' insurance. While the reasons for uninsurance among young adults have been documented, how they operate and are perceived on an individual level have not been explored in great detail. Further, it is poorly understood how the ACA policies and the state health insurance exchanges can serve young adults. Thus, we interviewed uninsured young adults aged 18-35 in northeastern Minnesota and northwestern Wisconsin and used inductive thematic analysis to explore these issues. Findings suggest that young adults don't feel at risk for health problems and therefore have low levels of health insurance literacy and place little value on health insurance. Multiple barriers to health insurance coverage, including the provision about staying on a parent's policy, persist despite the ACA. Our findings also suggest valuable lessons for state health insurance exchanges on how to better serve this population.