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Seeing Health Insurance and HealthCare.gov Through the Eyes of Young Adults

  • Charlene A. Wong
    Correspondence
    Address correspondence to: Charlene A. Wong, M.D., Robert Wood Johnson Foundation Clinical Scholars Program, University of Pennsylvania, 1303 Blockley Hall, 423 Guardian Drive, Philadelphia, PA 19104.
    Affiliations
    Robert Wood Johnson Foundation Clinical Scholars Program, University of Pennsylvania, Philadelphia, Pennsylvania

    Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania

    Division of Adolescent Medicine, Department of Pediatrics, The Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, Pennsylvania
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  • David A. Asch
    Affiliations
    Robert Wood Johnson Foundation Clinical Scholars Program, University of Pennsylvania, Philadelphia, Pennsylvania

    Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania

    Wharton School, University of Pennsylvania, Philadelphia, Pennsylvania

    The Center for Health Equity Research and Promotion, Philadelphia VA Medical Center, Philadelphia, Pennsylvania
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  • Cjloe M. Vinoya
    Affiliations
    Robert Wood Johnson Foundation Clinical Scholars Program, University of Pennsylvania, Philadelphia, Pennsylvania

    Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania
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  • Carol A. Ford
    Affiliations
    Division of Adolescent Medicine, Department of Pediatrics, The Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, Pennsylvania
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  • Tom Baker
    Affiliations
    Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania

    The University of Pennsylvania School of Law, Philadelphia, Pennsylvania
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  • Robert Town
    Affiliations
    Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania

    Wharton School, University of Pennsylvania, Philadelphia, Pennsylvania
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  • Raina M. Merchant
    Affiliations
    Robert Wood Johnson Foundation Clinical Scholars Program, University of Pennsylvania, Philadelphia, Pennsylvania

    Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania
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      Abstract

      Purpose

      We describe young adults' perspectives on health insurance and HealthCare.gov, including their attitudes toward health insurance, health insurance literacy, and benefit and plan preferences.

      Methods

      We observed young adults aged 19–30 years in Philadelphia from January to March 2014 as they shopped for health insurance on HealthCare.gov. Participants were then interviewed to elicit their perceived advantages and disadvantages of insurance and factors considered important for plan selection. A 1-month follow-up interview assessed participants' plan enrollment decisions and intended use of health insurance. Data were analyzed using qualitative methodology, and salience scores were calculated for free-listing responses.

      Results

      We enrolled 33 highly educated young adults; 27 completed the follow-up interview. The most salient advantages of health insurance for young adults were access to preventive or primary care (salience score .28) and peace of mind (.27). The most salient disadvantage was the financial strain of paying for health insurance (.72). Participants revealed poor health insurance literacy with 48% incorrectly defining deductible and 78% incorrectly defining coinsurance. The most salient factors reported to influence plan selection were deductible (.48) and premium (.45) amounts as well as preventive care (.21) coverage. The most common intended health insurance use was primary care. Eight participants enrolled in HealthCare.gov plans: six selected silver plans, and three qualified for tax credits.

      Conclusions

      Young adults' perspective on health insurance and enrollment via HealthCare.gov can inform strategies to design health insurance plans and communication about these plans in a way that engages and meets the needs of young adult populations.

      Keywords

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      Linked Article

      • Insuring Young Adults in the United States Through the Affordable Care Act
        Journal of Adolescent HealthVol. 57Issue 2
        • Preview
          The Patient Protection and Affordable Care Act (ACA), passed by U.S. Congress in 2010, represents an unheralded opportunity to meet the unmet health needs of young adults, a population that traditionally has represented a third of all the uninsured (ages 19–25 years), when compared with 16.3% among the general adult population (26–64 years) [1]. A motivating force for young adults' health insurance enrollment is that they represent an important pool of healthier covered lives; thus, offsetting the health care costs associated with sicker older adults.
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