Thomas Mahoney came out of a seizure last December surrounded by paramedics ready to take him to the hospital by ambulance. Mindful of the cost, he asked his mom and girlfriend to drive him instead, slipping in and out of consciousness along the way.
Maybe it wasn't the smartest option for a patient with epilepsy, but for a 21-year-old without health insurance, it was prudent.
Mahoney, of Dublin, Ga., lost his insurance when he turned 19, no longer eligible for coverage under his father's policy because he wasn't a full-time student.
Almost all states, when regulating insurance plans for small- and medium-sized employers, set a maximum age for coverage of dependent children. The limit is usually 19 for non-students and 23 for full-time college students.
Mahoney is just one of more than 13 million people between the ages of 19 to 29 without health coverage. Many are just starting out in their careers and have never had a serious health problem. Some refer to the group as "the invincibles" because so many take that good health for granted.
States are now looking at this group of young people as they seek to reduce the number of uninsured.
In the past two years, 17 states have passed laws that let young adults stay on the family policy until their mid-20s. New age limits range from 24 in Delaware, Indiana and South Dakota, to 30 in New Jersey. Eleven states settled on age 25, according to the Commonwealth Fund, which conducts health research.
Democratic presidential candidate Barack Obama has also picked up on the trend. Part of his health platform would let young people up to age 25 continue coverage through their parents' plans.
Mahoney said he explored continuing his coverage under his father's policy, but it would have cost about $1,500 a month — two-thirds of his income. Other policies would not cover his pre-existing condition.
His father "would by all means do whatever he could to get me covered and keep me covered," he said. "My mother is the same way."
The Commonwealth Fund projects that 1.4 million people would gain health insurance if every state extended dependent coverage to at least 23.
The ‘slacker mandate’
State lawmakers who specialize in insurance regulation, the National Conference of Insurance Legislators, will vote on a policy recommendation in two weeks that supports increasing the availability of dependent benefits up to age 25. The endorsement would be important because legislators around the country look to the organization for guidance on insurance issues.
"This is one way states can address a specific age group and not have to expend a lot of state resources to extend health coverage," said Laura Tobler, health program director at the National Conference of State Legislatures.
But not everybody agrees that states should take that step. Some refer to the extensions as the "slacker mandate."
The insurance industry says the extensions cause insurers to pay for care that consumers previously paid for out of their own pockets. When insurers have to pay more claims, they eventually have to raise premiums to cover those claims. For the most part, employers bear the added cost.
Mohit Ghose, a spokesman for America's Health Insurance Plans, said it's too soon to know how much insurance costs went up in states that extended eligibility for dependent coverage. When evaluating the additional requirements, he said, each one by itself amounts to a small increase in the cost of a policy, usually adding less than 1 percent. But, eventually, those mandates add up, and they can price health coverage out of range for some employers and their workers, he said.
"Sometimes when states jump on a bandwagon, it's not necessarily the right bandwagon for the people they're trying to help," said Susan Laudicina, director of state research and policy at The Blue Cross and Blue Shield Association.
A better solution is to let insurers offer a mix of plans that appeal to young adults, Ghose and Laudicina said. Such plans typically have low monthly premiums but require the patient to pick up a large chunk of initial medical expense. Plans targeting young adults tend to cost less because those age 19-23 generate about $1,500 in medical expenses a year compared with $3,200 for those 30-49 or $6,300 for those 50-64.
The Council for Affordable Health Insurance, which tracks mandated benefits, counts the "slacker mandate" as among the 1,961 mandates it's identified in all the states. Some require a small group or individual plan to cover a type of provider, such as a chiropractor. Others require the coverage of a particular illness, say Lyme Disease.
J.P. Wieske, the council's director of state affairs, said that staying on a parent's policy could come back to haunt young adults who develop serious health conditions. Once they develop a serious condition, like Thomas Mahoney did with epilepsy, they'll find it almost impossible to get insurance. But if they get their own health insurance before the problem hits, they'll have coverage that cannot be terminated.
"The sooner they can get on their own policies, the better off they'll be," Wieske said. "The rates will be cheaper and they're buying something they can keep with them."
Tobler said many twentysomethings have other priorities in their life now, and the new state laws simply acknowledge that reality.
"They're not thinking about getting sick. They're thinking about buying a car or putting a downpayment on a house or apartment," Tobler said.
Wieske is particularly critical of New Jersey's law, which extended dependent coverage in some cases until age 30.
But Sara Collins of the Commonwealth Fund said she believes the state's approach made sense.
"One of the fastest growing age groups in the uninsured are 19 to 29 year olds. Between 19 and 23, you're somewhat protected by your parents' plans," Collins said, referring primarily to college students. "But, this age group, from 24 to 29, you really are a new entrant in the labor force. When you are a new entrant to the labor force, you're more likely to be employed by companies that don't offer coverage."