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Next Steps in Incremental Health Insurance Expansions:

Who is Most Deserving

Issue Brief No. 12
April 1998
Peter J. Cunningham

resident Clinton's proposal to allow near-elderly individuals -- those between the ages of 55 and 64 -- to buy-in to Medicare is the latest initiative to expand health insurance coverage incrementally by targeting particular age groups. Health insurance expansions for children were passed last year, and assistance to young adults -- those age 19 to 24 -- has also been discussed. The rationale for targeting individuals in these age groups is that they are presumed to be vulnerable. However, vulnerability to uninsurance includes not only the risk of being uninsured, but also the potential health and financial consequences that result from not having coverage, each of which varies substantially across age groups. This Issue Brief examines the vulnerability of the near-elderly and young adults with respect to uninsurance.

Vulnerability to Being Uninsured

To target future expansions of health insurance, policy makers would benefit from a better understanding of how individuals in different age groups are vulnerable to being uninsured as well as the health and financial consequences of being uninsured. Differences in vulnerability imply that public policy initiatives to expand coverage for specific groups require different approaches.

Using data from the Community Tracking Study's Household Survey,¹ this analysis compares near-elderly persons with young adults and children on a number of criteria that are especially relevant for assessing vulnerability to uninsurance. These include:

the risk of being uninsured and the availability of insurance coverage to uninsured individuals;

the potential health and financial consequences of being uninsured as evidenced by differences in health status and health care use; and

the ability of uninsured persons to get needed health care.