July 2 2014 12:00 AM

Extending health coverage to the hardest-to-reach demographic

Niklous Koehler, 25, equates buying his own health coverage with a major life step.

“I’m prepared because it’s something that I have to do, but at the same time, it’s the last step to adulthood,” he said. “It’s always been in the back of my mind.”

Like many other twenty-somethings, Koehler doesn’t need much medical attention. He’s been to the hospital once recently that he can recall, and his last memories of visiting the doctor mostly involve high school sports physicals.

Despite his good health, as Koehler realized he would lose his parents’ coverage later this year when he turns 26, he started exploring his options.

“It’s really terrifying,” he said. “You don’t ever want to lapse (in coverage). I’ve had family members almost go into bankruptcy for health care bills.”

In preparation of finding his own plan, Koehler talked with friends who had signed up for health care under the federal exchange and researched premiums to ensure he could afford it. After “monkeying around” with the online signup program for the Affordable Care Act, he found out he can pay about $50 a month for a Silver Health Plan that covers standard doctor visits, prescriptions, emergency room visits and more.

But while Koehler is prepared to take charge of his health care, many of his peers aren’t. Young adults have historically made up a disproportionately high number of Michigan’s uninsured, mirroring a national trend. People ages 25-34 account for about 12 percent of the state’s non-elderly population, but make up 25.6 percent of uninsured residents, according to the Michigan Department of Community Health.

Healthy people in their 20s and 30s often delay enrolling in an insurance plan because they don’t think they can afford it, said Shawn Dhanak, spokesman for Michigan´s chapter of Enroll America, a nonprofit organization that connects people with insurance coverage. He said most young people who sign up can get covered for a monthly premium or $100 or less.

“Young adults are far less likely to have the pay necessary to buy health care insurance on their own,” he said. “They’re starting out their career and taking entry level positions that may not provide health coverage.”

Cost was one of the biggest concerns for Koehler, who estimates his yearly income at about $20,000. He is pursuing his graduate degree in French at Michigan State University, where he is employed as a graduate assistant and a tutor.

“I don’t want to spend more (on health insurance) than I do on my phone,” he said.

Dhanak said while most young adults are finding that they can get covered for a relatively affordable cost, and that it helps to have in-person consultants to explain where the costs are coming from and the alternatives.

“They can often have some sticker shock,” he said. “When people think of universal health care, they think of 100 percent free. But it’s still nominal compared to the costs of an unexpected hospitalization. That’s what we need to get out.”

Looking at the long term, premiums and other healthcare costs are expected to go down as more young and healthy people enroll.

Dhanak also hopes to get the word out about the federal exchange’s special enrollment period, which may affect many younger enrollees. Open enrollment for 2014 coverage ended in March, but under special enrollment guidelines, people can enroll beyond that deadline if they get married or divorced, have a child or change their career, among other things.

One of the best ways to spread this information, Dhanak said, is to meet young people where they are. In the next couple of weeks, Enroll America’s “Get Covered America” campaign will station volunteers at the East Lansing Summer Concert Series, the Avenue Café and the Allen Street Farmers Market to offer guidance and information about health insurance options.

“Young people are a hard-to-reach demographic,” he said. “They’re always busy and moving around, so it’s important to go where they’re comfortable.”

In April, Michigan launched the Medicaid expansion program Healthy Michigan, which has also been instrumental in connecting young adults to insurance coverage. Although the program is open to lowincome people ages 19-64, enrollees ages 19-34 make up almost half of the enrollees, Angela Minicuci of the Department of Community Health said.

“This plan helps a lot of hardworking young people,” Minicuci said.

As of Tuesday, more than 315,000 people have signed up for coverage under Healthy Michigan — almost 99 percent of the goal of 320,000 people that the state hoped to cover by December.

For Dhanak, these numbers are a reminder of how important access to health coverage is.

“Most young adults are young and healthy, but they need health care to remain young and healthy,” he said.