Joel C. Cantor: Covering Young Adults

Joel C. Cantor Sc.D., is the Director of the Center for State Health Policy and Professor of Public Policy at Rutgers University. Joel’s research interests focus on issues of health care financing and delivery at the state and local levels. He frequently advises the New Jersey government on health care policy, and he chairs the State’s Mandated Health Benefits Advisory Commission.

We talked to Joel about his SHARE project examining dependent coverage expansions in seventeen states. Read on to see what he has to say about the fearless 20-somethings, methodological twists, and getting his dream job.

Of all of our SHARE grantees, you’re studying the largest number of states. Your project evaluates seventeen states that seek to expand insurance coverage to young adults.

Across the nation, there is a trend among states to raise the age cap on young people’s eligibility for dependent coverage under private group insurance to the mid-20’s and sometimes higher. This represents a fairly narrow age range, so we need to look at a lot of states to ensure adequate sample sizes. Looking at seventeen states also adds variability to our analysis, which will give us a stronger basis to infer the impact of raising the age limit.

Were you surprised by the considerable diversity of the states that have enacted this type of reform?

This policy is a private market strategy that is appealing across the ideological spectrum. It is politically inoffensive and doesn’t cost the taxpayers anything. For this reason, it is also a feasible policy option for states in different budget situations.

Would the business community agree, particularly the insurers?

The specifics of the mandates vary in each state, but in the majority of states the costs are likely to be borne by the purchaser of the coverage. These mandates allow a wider group into the market, but they must pay their own way. So in a sense, it is costless to the business community or insurers, although there is likely to be some added administrative burden. This is in contrast to mandating something like in vitro fertilization, where the cost is spread across the premiums of everybody buying into the regulated market.

Is it as inexpensive to insure young adults as it is to insure younger children?

Every state is struggling with health insurance coverage, but nationally, the 19-29 age group has the highest rate of uninsurance. Their biggest health care expense in this age group is typically for maternity services and most states have designed policies to exclude those most likely to have those expenses, such as those who are married or have kids. It is not likely that they would be as inexpensive as children, but large increases in health care expenses are typically expected later in life.

At a time when young adults are supposed to be asserting their independence, why are they still tied to their parents for coverage?

This is a pretty fearless group. In developing our SHARE proposal, we worked with a developmental psychologist who explained that individuals don’t think much about the future and risk until they are in their late 20’s. So, left to their own devices, many in this group will not purchase coverage. These reforms engage their parents, who may be more motivated to have their adult children seek coverage.

Does your study require any innovative approaches to collecting information on this subpopulation?

We are conducting a state survey in New Jersey that includes questions about the respondents’ adult children who are not currently living in the household. Household surveys typically do not ask about members who are not living there, so it was a tricky addition to make. It is a methodological twist that may lead to an interesting analysis of a potentially eligible population in the state with the highest age of eligibility (30 years old) for adult dependent coverage.

Will your ability to get information be limited by how well parents know what their kids are doing?

Yes. For instance, young adults may not tell their parents how much they are making or whether their employer offers health insurance coverage. But, I think parents will know if their kids have coverage. They’re also quite likely to know what state their kids live in and whether they’re full-time students. It would be great to do a linked survey where we identified the adult dependents that do not live in the sample households and then conducted follow-up interviews with those adult dependents.

How did you find yourself in the field of academia with a particular focus on health policy in New Jersey?

I moved to New Jersey from Baltimore after graduate school and have been here ever since. For three years after leaving Robert Wood Johnson Foundation I worked as the Research Director for the United Hospital Fund in New York City. I was fortunate that my dream job appeared and it turned out to be just seven miles from my house. I came to Rutgers in 1999 to start up the Center for State Health Policy. The Center focuses on health policy issues in New Jersey. But an opportunity like the SHARE grant allows us to work on the national stage. Policy researchers cannot stay sharp unless they engage in issues outside their state.