Most college graduates bid farewell to their insurance plans the same day they bid farewell to their alma mater. Most. But some states and private insurance companies are addressing the increasing numbers of uninsured  young adults with programs or laws to make the transition to the working world a little easier, and healthier. The question is whether these policies are enough.

Going back as far as 1994, 26 states (see our maps below) have passed laws forcing insurance firms to allow young adults on their parents’ policies as dependents after their 19th birthday – and, in most cases, even if they are no longer a full-time student.

But these programs and laws are not helping enough of the graduates coming out of college each year or the parents who anxiously watch their children go without coverage.

“It makes me really angry,” said Deborah Vallejo, whose daughter Vivian lost coverage when she graduated last spring. “I think most parents worry a lot. Everyone should have a base, a foundation of services they can count on.”

Although many of these students have the option to continue their plans another 18 months on COBRA, the unsubsidized premiums and program fees total hundreds of dollars that neither graduates nor their parents can often afford.

“The persistent rise in the number of uninsured young adults each year reflects the spreading weaknesses in the United States voluntary, employer-based health insurance system,” testified Sarah Collins to the New York City Council Committee on Healthy in April. Collins co-authored a Commonwealth Fund investigating the lack of insurance coverage for adults aged 19 to 29. “As a country we depend nearly entirely on employers to provide health insurance.”

New Jersey allows single adult dependents as old as 30 to remain on group plans, and New York in July passed a bill that raises the maximum age there to 30 as well. In Florida, young adults can stay on their parents’ coverage up through age 25, but they can continue on the coverage through age 30 if they pay the same premium a single independent would pay.

But the patchwork legislation only impacts residents of those 26 states, and the laws don’t apply to large employers who self-insure. A company that chooses to take on the risk of its employees’ health issues without an underwriting insurance company, for example, does not have to keep on dependents after age 19.

State governments and federal officials could certainly do more to address the gaps in coverage among young adults, Collins said. Colleges and universities could require full-time and part-time students to have insurance while offering plans to students. A handful of states -– California, Idaho, Illinois, Massachusetts, Montana and New Jersey — already require full-time undergraduates to have health insurance.

For its part, the federal government could extend eligibility for dependents under private coverage beyond 18 in all states. It’s a proposal under consideration currently at the national stage as the Obama administration wrestles with Congress on how to ensure – and insure – a healthier United States.

But for all the talk, not many states are likely to follow soon in the footsteps of Massachusetts, which requires all its residents to have health insurance or pay an annual tax penalty. Still, some private companies, such as Aetna with their BodyGuard plans and Blue Cross with Tonik plans, have followed the state’s example for plans aimed specifically at young adults. The Massachusetts Commonwealth Connector, an independent state agency that helps residents comparison shop, has a section for those aged 18 to 26. And its website, www.getaplanman.com, with an interactive (and musical) vibe, aims to help them find an appropriate plan.

A similar funky feel greets visitors to www.tonikhealth.com, the Blue Cross Anthem site with special young adult plans offered in California, Connecticut, New Hampshire, Colorado, Nevada and Georgia. And the website ehealthinsurance.com is a sort of “Expedia” of health insurance shopping, says Prescott Perez-Fox, a 28-year-old New Yorker and graphic artist who bought his insurance through the site. Fifty-two percent of ehealthinsurance.com policyholders are younger than 35, the company reports, and they say they have sponsored surveys aimed at understanding this demographic better.

ehealthinsurance.com also found that 56 percent of college students think they will have coverage the day after they graduate and 70 percent of those covered under their parents’ plan say their folks are likely to buy them a plan if they can’t afford it. But with private insurance often too expensive or unavailable for those with preexisting conditions, and high premiums under COBRA, many parents cannot afford to help their kids.

Some states have expanded Medicaid programs to cover people over 18 who fall below various income thresholds. Most, however, require people to make next to nothing to qualify. Take Elyssa Gutbrod. When she lost coverage through her mother’s policy after graduating from Arizona State University, she couldn’t find coverage in Arizona or in Wisconsin, where, legally, she was still a resident as an undergrad. She has Factor V Leiden, a preexisting condition that predisposes her to blood clots and excludes her from private health plans. Her research into government programs in both states failed to yield alternatives.

“A lot of it is programs for very specific subtypes of people,” Gutbrod, age 26, said. “If I don’t make a lot of money and I need health insurance, I couldn’t find anything.”

Gutbrod does qualify for a special low-income program from GlaxoSmithKline, the United Kingdom-based pharmaceutical giant that manufactures her medication, because she falls below 250 percent of the federal poverty line. But she has turned down temporary jobs and balked at applying for some grants and government jobs – she has even considered delaying marriage – just to continue qualifying. She had to remain just poor enough, and those jobs and grants, or the combined income if she married her fiancé, would push her income too high for her to qualify, but earn her too little to afford the $8,000 monthly medication bill.

Collins, the Commonwealth Fund researcher, recommends extending the eligibility of more Medicaid public programs’ beyond age 18, which she says will help the 3.6 million uninsured adults aged 19 to 25 with incomes under 100 percent of the federal poverty level (FPL). Raising the eligibility ceiling to incomes under 200 percent of the FPL would affect another 7.6 million young adults, Collins said.

Colorado’s Healthcare Affordability Act, signed into law in February, includes a provision along these lines by expanding Medicaid to include childless adults — but only up to 100 percent FPL, which is $10,830.

Even those who do qualify for, and can afford, private health insurance encounter obstacles. Lauren Taylor, age 26, just moved from New Jersey to Los Angeles, where she does freelance public relations for a record label. In New Jersey, she paid $200 a month for very basic private insurance – her biggest expense after rent – but it didn’t cover preventive care, such as annual exams or physicals.

When she tried to find a new policy in L.A., she was turned down by one company because her records weren’t recent enough. The last time she had visited the doctor was 2006 since she’s healthy and doesn’t get sick often.

“Of course, if I had pages and pages of doctor’s visits, it would probably be related to some preexisting condition,” she wrote in an email. “I would be one of those people you hear about who is rejected for health insurance because they have the audacity to actually need and use health insurance.”

Even having her records sent from New York to L.A. took two months after multiple unreturned and two certified letters.

“Health insurance really makes my blood boil!” she wrote. “Which is probably a condition not covered by my insurance.”

Details on the laws in specific states that allow dependent coverage beyond age 18 can be found here.

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Tags: health, health care, identity, los, Los Angeles, multimedia, state laws, Texas

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