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Surprisingly, many young uninsured are risk-adverse
Many young and healthy uninsured individuals don't see themselves as invincible and in fact are risk-averse, according to a December 2010 study by the Washington, DC-based Center for Studying Health System Change (HSC).
"Contrary to what a lot of people often assume about the uninsured who are young and healthy, the study found that many do not perceive themselves as invincible, or that they can get by without insurance," says study author Peter Cunningham, PhD, a senior fellow and director of quantitative research at HSC.
This could mean that these individuals will be motivated to gain coverage through the state-based insurance exchanges, which will be created as a result of the national health reform law, says Dr. Cunningham. His study, Who Are the Uninsured Eligible for Premium Subsidies in the Health Insurance Exchanges? offers these key findings:
About half of the uninsured consider themselves to be risk-averse, including those who are healthy and have no negative experiences with the health care system.
Most uninsured individuals believe that they need health insurance, although fewer believe that it is worth the cost.
This could change, however, once premium subsidies are available in 2014, notes Dr. Cunningham. "The findings indicate that cost and affordability dominate the decision not to get health insurance, rather than the perception among some uninsured that they don't need it," he explains.
These findings have implications for eligibility and enrollment in the new state health insurance exchanges, according to Dr. Cunningham. "Those who are responsible for setting up the exchanges will need to realize that the individual mandate alone will not guarantee enrollment," he says.
Outreach and streamlined enrollment will be necessary to reach the healthy uninsured, says Dr. Cunningham, "although outreach strategies will probably be very different than for Medicaid."
Many individuals on Medicaid enroll at the time that they actually need health care, notes Dr. Cunningham, and continuous open enrollment in Medicaid ensures they are able to do that. Medicaid also doesn't require any premium payments, so there is no cost to enrolling for the patient, regardless of whether they need care immediately or not, he explains.
"For the exchanges, it will be a much more challenging task to get the uninsured enrolled in something that they may not immediately need, but will have to pay for anyway," says Dr. Cunningham.
However, the federal government will require defined open enrollment periods, notes Dr. Cunningham, which means that people will only be able to enroll in the exchanges at certain times of the year. "Hopefully, this will help by getting people to think about the financial risks of not enrolling if they have an unexpected health problem," says Dr. Cunningham.
Contact Dr. Cunningham at (202) 484-4242 or PCunningham@hschange.org.