The New England Journal of Medicine has a pretty cool graph of how the uninsurance rate has changed by age and by year:
#HealthPolicy Data Watch: Uninsured Rate by Age https://t.co/iEodXLvlx9 pic.twitter.com/897C4k9j1q
— NEJM (@NEJM) October 12, 2016
What are some of the big drivers of this?
65+ is easy. People automatically qualify for either Medicare or Medicare Advantage. There is massive uptake as it is massively (and rightly) subsidized with significant late enrollment penalties.
Kids are pretty easy too. The first source of coverage for kids is employer sponsored insurance if one of their parents or guardians has it through work. But there is a comprehensive safety net in place. The CHIP program is awesome and it provides very good insurance to kids whose parents and guardians in the lower and middle middle class. Most states’ legacy Medicaid programs also covered kids up to the point where they qualified for either fully subsidized or mostly subsidized CHIP coverage. Medicaid usually covers between a third and half of all births in the states. There are a number of programs that create a reasonably effective if not particulary efficient wrap-around health care system for kids.
And then we get to the interesting area. Working age adults. Uninsurance rate decreases by age. This makes sense for three reasons. First, the primary source of coverage for working age adults is insurance through work. Low wage work and intermittent work is far less likely to offer insurance than medium or high wage steady work. Wages tend to increase as people age into middle age so the odds that a particular job with health insurance is filled by a 21 year old is significantly less than the odds it is filled by a 39 year old.
Secondly, a fall back system for older Americans is the disability system. People are more likely to either get on Medicaid for specific disease conditions or long term Medicare disability because incapacitating conditions are more likely to strike older people than younger people. There are 22 year olds on Medicaid for chronic conditions but they are swamped by 58 year olds.
Finally, motivation if a factor. A 62 year old is far more motivated to get insurance as they know that their hip is a bit rickety, that cancer runs in their family, that their breathing is a bit rough. A 22 year old in the prime of their life is far less likely to care as the relative risk of anything short of getting hit by a bus or suffering the consequences after saying “Dude, hold my beer and watch this” are very low. This calculation changes for young women due to pregnancy risk but it is similar.
As a side note, we should see the little jump at age 27 in uninsurance rates. That is the ACA at play there as people are moving off their parents’ insurance to uninsured.