Improving the Health, Safety, and Well-Being of Young Adults Workshop Summary (2013) / Chapter Skim
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8 Health Care
8 Health Care
Pages 69-82
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From page 69... ...
• The Patient Protection and Affordable Care Act (ACA) ad dresses the health needs of young adults through the broaden ing of private insurance coverage, expansion of Medicaid, and the provision of essential health benefits, but gaps in health care for young adults will remain.
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From page 70... ...
Young adults often have more difficulty accessing health services than do the members of other groups. They traditionally have the lowest rates of insurance coverage of any group, with the poor and near poor most affected.
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From page 71... ...
Several professional organizations have developed recommendations covering the transition from pediatric to young adult care for those with chronic conditions. However, according to the National Survey of Children with Special Health Care Needs, only 39 percent of families report that their children ages 15 to 17 receive the necessary services to transition to adult health care, work, and independence (CDC, 2010)
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From page 72... ...
However, even this amount can place a significant challenge on those who do not have assistance from family members. Insurance status has a major effect on the health care of young adults, with those who are uninsured less likely to fill a prescription, skip a test or treatment, or forgo specialist care (see Figure 8-1)
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From page 73... ...
While some groups may have sources of care -- such as those in college, the military, or prison -- others do not -- such as those who are homeless, are leaving foster care or the justice system, or have chronic conditions. Furthermore, "carve-out" arrangements -- in both public and private insurance -- separate the mental health and physical health delivery systems, which impedes referral or care coordination and often precludes reimbursement for primary care clinicians.
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From page 74... ...
Prior to ACA, Medicaid was required to cover children and pregnant women at income levels up to at least 133 percent of the federal poverty level, and adolescents up to at least 100 percent, but the income eligibility levels for single adults, including young adults, were very low in the vast majority of states. ACA increases the income eligibility level for adolescents, requires the states to at least maintain their past efforts in Medicaid, and provides for expansion of Medicaid starting in 2014; originally it was a requirement, but it became an option subsequent to the Supreme Court's ACA decision in 2012 (English and Park, 2012)
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From page 75... ...
At the time of the workshop, 25 states had indicated that they were planning to expand Medicaid, while the remainder were demonstrating a reluctance to do so.1 In addition, some of the states that are not planning to expand Medicaid include ones that have very low income eligibility levels for young adults. The expansion is critical for young adults, said English, because they lag behind adolescents and other adults in public health insurance coverage.
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From page 76... ...
These effects should be examined closely to inform policy makers about changes that are needed and to inform advocates about what additional steps are needed to meet the legislation's promise. YOUNG ADULTS FACING PARTICULAR ISSUES Many groups of young adults face particular health challenges, said Tamera Coyne-Beasley, professor in the Departments of Pediatrics and Internal Medicine at the University of North Carolina, Chapel Hill, including • Young adults who have been in the juvenile justice system • Immigrants • Members of the military • Young adults with special health care needs • Rural young adults • Young adults who have been in the foster care system • LGBTQ (lesbian, gay, bisexual, transgender, and queer/questioning)
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From page 77... ...
Unemployed young adults report higher levels of risky drinking and lack of physical activity in their leisure time, though employed individuals have higher levels of smoking, higher french fry consumption, and low fruit and vegetable consumption (Caban-Martinez et al., 2011)
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From page 78... ...
. Among young adults leaving foster care, a quarter suffer from posttraumatic stress disorder, and most are at high risk of losing Medicaid or other forms of insurance coverage when they age out.
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From page 79... ...
However, disparities exist in vaccine uptake. A culturally competent health care system that provides access to at least annual visits and medical homes for all young adults must include transition care to help young adults navigate the health care system, CoyneBeasley said.
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From page 80... ...
Universal preventive programming could help all young adults avoid problems, while a closer matching of programs to young adult health risks and subpopulations could target those groups at greatest risk. As an example, Oesterle mentioned programs focused on obesity for young adults.
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From page 81... ...
Applying and adapting successful programs could bring widespread public health impacts, Oesterle concluded.
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