The Massachusetts health reform law (often called “chapter 58”) made several special provisions for young people (defined as those between 19 and 26), because they represented a disproportionate share of the uninsured population, and were less likely to have access to insurance through work (as most of the jobs available to people in that age group don’t come with insurance). The Urban Institute recently reported a study of the impact of chapter 58 on insurance rates among young people which showed that these special provisions have worked as intended. The uninsurance rate in this group fell 60% (from 21% to 8%, in round numbers).

Achieving this goal, though, required some compromises. Young adults were largely brought into the insurance fold via “Young Adult Plans”, insurance plans with important exclusions and relatively high deductibles. In addition, many have annual maximum coverage amounts (usually around $50,000). Most young people will be fine with these restrictions, as most people in this population are healthy. These plans are similar to the “college plans” which were available before reform; unfortunately, these plans were cited in a 2009 article in the Boston Globe for having higher administrative costs, and that slightly less than 1% of covered students exceeded the $50,000 cap on benefits (951 people)(Link to complete study result). A more recent investigation by the New York attorney general reported in the Chronicle of Higher Education showed that these issues are neither limited to Massachusetts nor have they stopped due to the investigations in Massachusetts.

Regardless of the potential downsides to Young Adult Plans, they do bring important benefits. Access to primary care, in particular, is an enormous benefit (all Massachusetts plans require at least three routine primary care visits be covered). And in the spirit of beginning as we mean to go on, getting people insured in their youth may form a habit of receiving regular preventive care which can translate into benefits in later life, as well as benefits now through the screening and teaching which are big components of the primary care visit. There hasn’t yet been an analysis of the downsides, and while the statistics suggest there are few people who outrun the limitations of a young adult plan, for those who do the impact, financially and personally, can be devastating.