The New Health Dialogue

According to a new report by the Commonwealth Fund, young adults are going to win under the new health reform law. Nearly all of the 13.7 million uninsured young adults will get insurance coverage over the coming years, largely from significant Medicaid expansions, the provision that allows young adults to stay on their parents' insurance until the age of 26 and from the new exchanges and federal subsidies launching in 2014.

Starting in 2014, everyone earning a certain salary must carry health insurance. The Congressional Budget Office maintains that the "compliance of young adults will be particularly important in terms of creating broad and diverse risk pools in the exchanges and individual markets" and estimates that "the influx of young and health people into the exchanges and individual markets will lower premiums by 7 percent to 10 percent."

But the catch? Even though it's a mandate, we're still not sure they're all going to play. Based on a 2009 survey that asked 19-29 year olds if they favor a reform proposal requiring everyone to carry health insurance, 62 percent said they were strongly or somewhat in favor. Democrats with incomes under $20,000 were more likely to be in favor of the mandate than Republicans and those with incomes over $60,000.

Under the new law, young adults earning below 133 percent of poverty will be eligible for Medicaid and young adults earning less than $9,350 will be exempt from the mandate. Young adults with incomes between 133 and 250 percent of poverty will have premium contributions capped at between three and eight percent of income, and young adults with incomes between 250 and 400 percent of poverty will have premium contributions capped between 8.1 and 9.5 percent of income -- or face small penalties. But the difference between the cost of the penalty -- and the cost of insurance -- could mean additional disposable income, which for the young and healthy, may be priceless.

Time will tell. The authors of the report are adamant that affordability and ease of enrollment will be critical for compliance. The authors cite three factors -- ease and affordability, penalties and specific sign-up periods -- as being indicative of high compliance for other types of mandates in the U.S. and health inurance mandates in other countries. The government and insurers will need to put on their thinking caps and get creative. In Massachusetts, for example, the state achieved a coverage rate of over 97 percent in part due to the innovative ways residents were both motivated and educated about coverage. For example, the Massachusetts Health Connector teamed up with the beloved Red Sox. If it's good enough for the Sox, it must be good enough for the rest of us.