New report: Rate of uninsured young adults drops by more than one-third in Texas

August 23, 2016

HOUSTON - (Aug. 23, 2016) - The percentage of young adults ages 18 to 34 in Texas without health insurance has dropped by 35 percent since the Affordable Care Act (ACA) went into effect, according to a new report released today by Rice University's Baker Institute for Public Policy and the Episcopal Health Foundation.

The report found the uninsured rate among young adults in Texas dropped from 33 percent in September 2013 to 21 percent in March 2016. This age group is often called "young invincibles" by the health insurance industry because they don't always purchase health insurance since they believe they are too healthy to warrant the cost.

Prior to the ACA going into effect, young invincibles had higher uninsured rates than older Texans. However, the report found this group of young Texans now has a lower uninsured rate than Texans ages 36 to 49.

"We found a significant increase in young adults getting health insurance through employer-sponsored health plans," said Vivian Ho, the chair in health economics at Rice's Baker Institute and director of the institute's Center for Health and Biosciences, a professor of economics at Rice and a professor of medicine at Baylor College of Medicine. "The ability of many young invincibles to remain on their parents' plans likely explains a substantial part of the drop in the uninsured."

Under the ACA, children up to age 26 can remain on their parents' health plan.

Researchers say the ACA provision requiring large employers to make affordable health insurance available to employees and the strong Texas economy may also have contributed to the rising rates of health coverage for young invincibles as well as Texans overall.

The report discovered Hispanics and young adults making less than $16,000 a year were the most likely young invincibles in Texas to remain uninsured. Researchers found more than one-third of young Hispanics and 56 percent of low-income young adults in Texans still do not have health insurance.

"For those young adults with the lowest incomes, the ACA coverage solution was an expanded Medicaid program," said Elena Marks, EHF's president and CEO and a nonresident health policy fellow at the Baker Institute. "Because Texas has not yet opted to use the federal Medicaid dollars to cover these individuals, it's likely they'll remain uninsured."

The participation of young invincibles in the ACA health insurance marketplace is important to its long-term success, the report said. Researchers said the lack of sufficient young invincibles and other healthier adults enrolled in ACA marketplace plans is cited by some as a factor in anticipated increases in 2017 premiums and the withdrawal of large insurance carriers from some state health insurance marketplaces.

"The composition of risk pools -- including a mix of healthier and less healthy participants -- is vital for the long-term sustainability of the ACA health insurance marketplace," Ho said.

Marks said outreach and enrollment organizations should develop new approaches to reach young adults in Texas, especially those who paid the escalating tax penalty fee for being uninsured.

"Another promising strategy is to encourage enrollment groups to assist young adults who are aging out of Medicaid and CHIP (Children's Health Insurance Program) and help transition them to ACA marketplace insurance plans or other coverage," Marks said. "Youth-friendly e-outreach during the upcoming open enrollment period may also be effective."

The report is the 23rd in a series on the implementation of the Affordable Care Act in Texas co-authored by Marks and Ho.
The Health Reform Monitoring Survey (HRMS) is a quarterly survey of adults ages 18-64 that began in 2013. This report is a summary of data extracted from the HRMS surveys in Texas administered between September 2013 and March 2016.

The HRMS is designed to provide timely information on implementation issues under the ACA and to document changes in health-insurance coverage and related health outcomes. The Baker Institute and EHF are partnering to fund and report on key factors about Texans obtained from an expanded, representative sample of Texas residents (HRMS-Texas).

The HRMS was developed by the Urban Institute, conducted by GfK and jointly funded by the Robert Wood Johnson Foundation, the Ford Foundation and the Urban Institute. The analyses and conclusions based on HRMS-Texas are those of the authors and do not represent the view of the Urban Institute, the Robert Wood Johnson Foundation or the Ford Foundation.

To schedule an interview with Marks, contact Brian Sasser, director of communications at the Episcopal Health Foundation, at or 832-795-9404.

To schedule an interview with Ho, contact Jeff Falk, associate director of national media relations at Rice, at or 713-348-6775.

Related materials:

Full survey report:

Episcopal Health Foundation:

Marks bio:

Ho bio:

The Episcopal Health Foundation was established in 2013 and is based in Houston. With more than $1.2 billion in estimated assets, the Foundation is a 501(c)(3) not-for-profit corporation that operates as a supporting organization of the Episcopal Diocese of Texas. EHF works to improve the health and well-being of the 10 million people in the 57 counties of the Diocese by investing in communities through grant-making, outreach to Diocesan churches and critical research to advance community health.

Founded in 1893, Rice University's Baker Institute ranks among the top 10 university-affiliated think tanks in the world. As a premier nonpartisan think tank, the institute conducts research on domestic and foreign policy issues with the goal of bridging the gap between the theory and practice of public policy. The institute's strong track record of achievement reflects the work of its endowed fellows, Rice University faculty scholars and staff, coupled with its outreach to the Rice student body through fellow-taught classes -- including a public policy course -- and student leadership and internship programs. Learn more about the institute at or on the institute's blog,

Rice University

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