Reckless in the pursuit of fortune and glory? The characteristics of California's uninsured young invincibles and a strategic approach to increasing health insurance enrollment

Young Invincibles (YI) are a subset of the population that has a greater likelihood of being uninsured. With the implementation of the Affordable Care Act (ACA) and the creation of California's state-based health care exchange, Covered California, the uninsured rates for YIs have steadily declined since 2014. Despite this achievement, they are still the demographic in the state that is most likely to be uninsured. With the repeal of the federal individual mandate, efforts to close this cohort's insurance gap is projected to erode as the likelihood of this cohort to be uninsured will increase. This thesis attempts to better understand the characteristics of the uninsured YI population and determine the effects of the ACA on this cohort. I aim to inform California policy, while identifying marketing and outreach efforts that will enroll them in health insurance. Utilizing insight gleaned from existing literature and a regression analysis, I analyze the characteristics associated with those who are more likely to be uninsured. Using three datasets, a 2013 and a 2017 data set from the California Health Interview Survey (CHIS), and a third I created by combining both data sets, I conduct logistic regression analyses to determine the characteristics of the insured, examining age (26 to 34-year-olds), measures of invincibility among other demographic variables, holding all factors constant. I find several statistically significant variables. Given the learnings from the literature review and my results, I conclude that while improvements have been made to help YIs enroll in insurance coverage, YI men were left behind. My findings also suggest that perceptions of invincibility could be influencing insurance enrollment. I offer policy considerations to help expand enrollment to this demographic, including a state-imposed mandate, subsidies to individuals above the income threshold, as well as a suggested framework to limit the number of qualifying exemptions. Moreover, I provide recommendations for marketing and outreach efforts that use these characteristics to target YIs and encourage them to enroll in health insurance.