With the health policy world in a holding pattern until the U.S. Supreme Court issues its ruling on the legality of the Affordable Care Act (ACA), attention has turned to the law’s various reforms and what their future might be if the ACA is overturned. The provision that allows children to stay on their parents’ health insurance until age 26 (if their parents’ coverage includes dependents) has garnered particular scrutiny, as polls have consistently found that it is one of the law’s most popular elements.
In that context, which regions of the country have the most to lose if the ACA is struck down? According to a new report from the Commonwealth Fund, families in the Midwest have taken the most advantage of the allowance since the law passed in 2010, while Southern families have lagged behind. The group polled a national representative sample of more than 1,800 adults, between ages 19 and 25, in November 2011. Results were broken down by region. The survey found:
60 percent of Midwest young adults stayed on or enrolled in their parents’ health plan in the previous 12 months. The percentage dropped to 51 percent in the Northeast, 49 percent in the West and 36 percent in the South. Midwest young adults were also most informed about the new policy (69 percent awareness). Those figures followed the same pattern: 65 percent in the Northeast, 57 percent in the West and 50 percent in the South. Wealthier (65 percent adoption rate among those above 250 percent of the federal poverty line versus 25 percent among those below) and better-educated families took greater advantage of the provision. Unsurprisingly, those in the Midwest (64 percent above 250 percent of federal poverty line) and Northeast (69 percent) generally had higher incomes and more education compared to those in the West (51 percent) and South (52 percent). “There is a strong correlation in the survey of young adults having health insurance if their parents have insurance,” said Sara Collins, vice president for affordable health insurance at the Commonwealth Fund, in an interview. “We know uninsured rates in general are much higher in the South. You see that showing up in this data. Their parents may be more likely to be uninsured or have a policy, maybe through a small employer, that doesn’t include dependent coverage.”
The correlation of income and education levels with utilization of the ACA age-26 provision (and its subsequent association with certain areas of the country) was strong, Collins said. In addition to the numbers above, only 14 percent of young adults who had not graduated from high school had attained insurance through their parents, compared to 65 percent of those with some college or technical education.
The U.S. Department of Health and Human Services (HHS) has routinely boasted about the law’s ability to help young people obtain insurance. According to a report produced by the department, an additional 2.5 million Americans between ages 19 and 25 were insured in June 2011 than were in September 2010 when the policy went into effect. The Commonwealth Fund placed the number of young adults who were insured because of the ACA’s age-26 provision (and without it would likely not have been able to acquire insurance) at 6.6 million.
According to a New York Times/CBS poll in April, 68 percent of Americans approve of the allowance, while just 28 percent disapprove. That makes the age-26 coverage requirement much more popular than the ACA as a whole (approval for the law hovers at 41 percent, according to a poll taken by the Kaiser Family Foundation shortly before the Supreme Court hearings, with 40 percent disapproval).
House Republicans have indicated that they would be amenable to reintroducing popular aspects of the law (and named the age-26 coverage provision specifically as one such aspect) if the Supreme Court were to overturn the entire ACA. As U.S. House Speaker John Boehner (R-Ohio) told POLITICO last month: “When the court rules, we’ll be ready.”
View the full Commonwealth Fund report below.