The issue brief, "Rite of Passage? Why Young Adults Become Uninsured and How New Policies Can Help," was released last month by the Commonwealth Fund, a private foundation focusing its research on health and social issues.

According to the report, nearly 14 million Americans between the ages of 19 and 29 were uninsured in 2004, up 2.5 million from just four years earlier. 

Some 40 percent of 19 to 23 year-olds who do not attend college lack coverage, usually because they have been dropped as dependents from their parents health plan at work. 

About 20 percent of those who do attend college full-time or part-time are uninsured while they are in college, and the percent almost doubles as soon as they graduate.  For example, 38 percent of those who graduated between 1996 and 2000 lacked coverage for at least part of the year following their graduation.

Young people in poverty find themselves dropped from their family's publicly-funded health plan once they turn 19.  They can no longer ride on the coat tails of their low-income custodial parent for eligibility, and low-income singles generally don't qualify unless they are disabled.

Many young adults from poor families can't afford to attend college full time, so they wind up working at low-wage jobs without health benefits. Some 43 percent of workers ages 19 to 29 who earn less then $10 per hour are uninsured.

"As a result of the combined impact of such public and private insurance rules, uninsured rates jump sharply at age 19," the issue brief notes.  "Turning 19 increases the risk of
being uninsured by more than twofold: the uninsured rate rises from 12 percent among children age 18 and under to 31 percent among those ages 19 to 29."

The report concludes that low-income young adults are particularly vulnerable.  "Among those living in families below the poverty level, more than half (54%) are uninsured."

Among employers who offer dependent health coverage as a benefit, nearly 60 percent do not insure dependent children over age 18 or 19 if they do not attend college.

To address this problem, some state governments are passing laws requiring state-regulated health plans to continue coverage for several years beyond 18, regardless of the educational status of a dependent.  New Jersey, Colorado, Massachusetts, Utah, and New Mexico have passed laws extending the age at which dependent coverage may be terminated.

The Commonwealth Fund does not just complain about the health insurance problem of young Americans.  It offers three specific proposals to address this issue.

Congress could allow or require states to extend coverage to those young adults in Medicaid and SCHIP (State Children’s Health Insurance Program) who lose their eligibility because of age, with federal matching funds provided.  A policy change such as this would help the 2.9 million uninsured young adults ages 19 to 23 with incomes under 100 percent of poverty.

State legislatures could pass laws, similar to the handful mentioned above.  Even if the cut off age were only increased from 18 to 23 for dependents who are not in college, this would provide coverage to an estimated 1 million young adults.

Finally, states could ensure that all colleges and universities require part-time and full-time students to have health insurance.  Most private schools, and about 25 percent of public universities, already have such a requirement in place. 

"Increasing the number of schools that require students to have health insurance coverage and that offer such coverage through state mandates could help cover the 1.9 million part-time and full-time uninsured students ages 19 to 23," the report states. "Federal or state subsidies for premiums would help offset the costs of insurance coverage for students."

Millions of young people are dropped from their parents’ policies or public insurance programs at age 19 or on graduation day.  They must scramble to find insurance on their own as they make the transition from high school to work or to college. 

Turning 19 should be a cause for celebration and eager anticipation of the challenges of adulthood.  For millions of young people it is, but for millions of others it is a sobering reminder that, when it comes to their health, they are truly on their own without a safety net.

The Commonwealth Fund has done a public service by bringing this problem to our attention in such a well-documented and thoughtful report.  Their recommendations deserve to receive careful consideration by Congress and state legislatures.