HEALTH INSURANCE ENROLLMENT, EDUCATION, AND EMPOWERMENT

The 3 E’s: Health Insurance Enrollment, Education, and Empowerment for Young Adults

Hanna Kristina C. Sahagon

University of San Diego

 HEALTH INSURANCE ENROLLMENT, EDUCATION, AND EMPOWERMENT 2

Executive Summary

Kaiser Permanente (KP) is a well-established Health Maintenance Organization (HMO), and they

offer a wide selection of health insurance plans for individuals and families. As one of the leading

healthcare providers and non-profit insurance plans in the United States, KP has become interested in

decreasing the number of uninsured young adults between the ages of 19-34. Out of all age groups, young

adults make up the largest group without health insurance coverage. As a result of not having health

insurance, young adults tend to frequent emergency departments more and are more likely to not have a

primary care physician. This often drives up the cost of healthcare for young adults and can also affect other

members of the population. KP intends to create an online health insurance seminar to increase health

insurance consumer knowledge among young adults. The health insurance seminar aims to ensure

participants are prepared to navigate the health insurance market and that participants are able to select an

insurance plan that will work with their lifestyle and budget. The program has overarching goals of

increasing the overall number of insured young adults, between the ages of 19-34, increasing the number of

young adults with a primary care physician, and decreasing the number of emergency room visits of young

adults. KP has pledged 1 million dollars to this initiative. It is estimated that this amount will cover the

project development and pilot testing, but further funding may be needed to ensure the continuation of the

program. Upon successful meeting of the project goals and objectives, it is our hope that KP will continue

to fund the health insurance seminar program so more young adults can become educated about the health

insurance market and eventually insured members of the population.

HEALTH INSURANCE ENROLLMENT, EDUCATION, AND EMPOWERMENT 3

After the Patient Protection and Affordable Healthcare Act (ACA) was implemented, the number

of uninsured Americans decreased to 28.6 million in 2016 (Gunja & Collins, 2019). One of the most

known provisions of the ACA is the Dependent Coverage Mandate (DCM), which allowed adult

dependents to remain on their parent’s health insurance plan until age 26 (Gunja & Collins, 2019). While

this provision increased access to health insurance for a portion of the young adult population, it is

estimated that 30% of adults, ages 19-34, remain uninsured (Scott et al, 2015).

Adults, ages 19-34, make up the largest age demographic of those without health insurance in the

United States (Gunja & Collins, 2019). Specifically, 26-year-old adults were the most uninsured as nearly

20% did not have health insurance (Barnett & Vornovitsky, 2016). In young adults, the biggest deterrents

from obtaining health insurance were cost, lack of health insurance literacy, and the stress and time lost

from selecting a health insurance plan (Wong et al, 2015). Young adults felt challenged by the complexity

of obtaining health insurance, and this was further complicated due to being an inexperienced health

insurance consumer (Wong et al, 2015).

In order to mitigate the process of obtaining individual health insurance, Kaiser Permanente (KP)

has selected young adults as their target group for the 2021 fiscal year. KP is known to most as an

established Health Maintenance Organization (HMO), and they offer health insurance plans for

individuals and families. KP’s beginnings can be traced back to World War II, where Dr. Morris Collen, a

Permanente doctor, treated pneumonia among shipyard workers. KP has since evolved into one of the

United States’ leading healthcare providers and non-profit health plans. The mission of KP is to, “exist(s)

to provide high-quality, affordable health care services and to improve the health of our members and the

communities we serve” (Kaiser Permanente, n.d., para 4). KP is especially concerned for the uninsured

young adult population as their lack of insurance has great effects on the remainder of society through

cost sharing, increased premiums, and higher taxes (Cantiello, et al 2015).

As the largest age group without insurance, it is pertinent that more programs, especially within

insurance companies, are created to assist young adults with obtaining and selecting a health insurance
HEALTH INSURANCE ENROLLMENT, EDUCATION, AND EMPOWERMENT 4

plan that fits their medical needs and budget. Furthermore, it is important for insurance companies to

empower young adults to take responsibility for their knowledge to become a better health insurance

consumer. In order to increase access to health insurance and health insurance literacy among young

adults, KP wants to create a health insurance seminar that is available to young adults, ages 19-34,

throughout San Diego County as a pilot test site. The health insurance seminar is a 1-hour program that

offers information about private and public insurance, how and when to enroll in an insurance plan, and

how to select an insurance plan that works for one’s budget and health needs.

Needs and Problems

From 2005 to 2010, the around 30% of young adults were uninsured (McClellan, 2015). Prior to

the ACA, there was little to no focus on decreasing percentage of young adults without insurance (Wong

et al, 2015). The ACA was the Obama Administration’s attempt at addressing the high rates of uninsured

young adults (Gunja & Collins, 2019). As mentioned previously, the ACA introduced the DCM, which

allows young adults to remain on their parents’ health insurance plan until age 26 (Gunja & Collins,

2019). There was a strikingly large increase in insurance status among young adults between the ages of

19 and 25 (Sommers, 2017). However, insurance rates among young adults between the ages of 26 and

35 were not significantly affected (Sommers, 2017). Young adults also benefitted from the Medicaid

expansion and the health insurance exchange that were implemented by the ACA (Bonnie et al, 2014).

When the ACA was enacted, it was estimated that 3 million young adults obtained health

insurance coverage (Griffith, 2020). The percentage of insured young adults continued to increase until

2016 (Griffith, 2020). However, in 2017 when the Trump Administration made significant changes to the

ACA, the percentage of insured young adults decreased, and it is estimated that 436,000 young adults

lost coverage (Griffith, 2020).

A lack of health insurance impacts young adults in a multitude of ways. Young adults have high

rates of emergency department use (Narendorf et al, 2017). It is no surprise that young adults also have

low utilization of preventative care services (Bonnie et al, 2014). Young adults are also more at risk for
HEALTH INSURANCE ENROLLMENT, EDUCATION, AND EMPOWERMENT 5

catastrophic health expenditures, which is when unexpected medical visits exceed 40% of one’s income

after necessities have paid for (Scott et al, 2018). It is estimated that nearly 50% of young adults have

difficulty paying for medical bills (Centers for Medicare and Medicaid Services, n.d., para 4).

The large portion of uninsured young adults also has impacts on other members of society.

Because young adults are typically more healthy than middle and older aged adults, insurance companies

rely on their good health to increase cost savings and lower premiums for their other members (Cantiello

et al, 2015).

Goals and Objectives

1. Among those who participated in the health insurance seminar, increase the number of insured

participants by 80% after the 2022 enrollment period ends.

Gaining access to health insurance showed significant increases in access and utilization of

healthcare and self-reported health (Garfield, 2020, para 7). Enrolling young and healthier individuals

support the costs of those who are at higher risk (Wong et al, 2015).

2. Among those who participated in the health insurance seminar, increase the number of

participants who have a regular primary physician by 70% after the 2022 enrollment period ends.

In a survey of young adults, participants perceived having primary and preventative care as the

biggest advantage of having a health insurance plan (Wong et al, 2015). Additionally, when patients are

established with a primary doctor, they are able to build rapport and trust with their provider, which is

associated with patients being more involved in their healthcare decisions (Dang et al, 2017).

3. Among those who participated in the health insurance seminar, decrease the number of

emergency room visits by 30% by the end of the 2021 calendar year.

Young uninsured individuals often use the emergency room to seek primary care because they

lack a primary physician (Hernandez-Boussard et al, 2014). By decreasing the amount of emergency
 HEALTH INSURANCE ENROLLMENT, EDUCATION, AND EMPOWERMENT 6

room visits, it will mitigate the overcrowding of emergency rooms, decease waiting times, decrease

medical errors, and increase patient mortality (Salway et al, 2017).

Timetable

ACTIVITY IMPLEMENTATION TIME RESPONSIBILITY

Month 1 Month 2 Month 3

1. Create seminar for health insurance

information
1.1 Research, with specific focus XXXXXXXX Health Insurance Consultant
on young adults ages 19-34
1.2 Create a lesson plan XXXXXXXX Health Insurance Consultant
1.3 Write a script for seminar XXXXXXXX Health Insurance Consultant
teacher to follow
1.4 Create pre- and post-seminar XXXXXXX Project Manager
evaluations.
2. Seminar video production
2.1 Film seminar videos XXXXXX Videographer and Seminar
Teacher
2.2 Edit raw footage XXXXXX Video Editor
3. Website design
3.1 Code website to support video XXXXXXXX Website Developer
and learning modules
3.2 Ensure website is aesthetically XXXXXXXX Graphic Designer
pleasing
3.3 Upload edited seminar videos to XXXXXX Website Developer
the website
4. Pilot testing
4.1 Recruit young adults to test the XXXXXXX Project Manager
website and seminar
4.2 Troubleshoot any issues XXXXXX Project Manager
reported by test group
5. Marketing and Visibility
5.1 Establish ads and other social XXXXXXXX XXXXXXX Marketing Specialist and
media marketing to market the Graphic Designer
seminar to YAs
5.2 Work with KP Marketing to XXXXXX Marketing Specialist and
disseminate advertising materials to Graphic Designer
current members with young adult
dependents.

Budget
 HEALTH INSURANCE ENROLLMENT, EDUCATION, AND EMPOWERMENT 7

KP awarded a budget of 1 million dollars for this initiative. $600,000 of the budget will go

towards payroll. $100,000 will go towards ads and marketing. $20,000 will go towards the cost of the

website, including domain license. $10,000 will go towards video and editing equipment that the

videographer and editor will need. $100,000 will go towards the evaluation process, including survey

development, distribution, and analysis. The additional funds will be stored for any emergency usage,

including salary for additional staff if needed. The funds will be managed by the project manager in

conjunction with the KP Grants Department.

Key Personnel

Sponsor Kaiser Permanente

Project Manager Dr. Brenda Boone
Team Health Insurance Consultant, Videographer, Seminar Instructor,
Video Editor, Website Developer, Graphic Designer, Marketing
Specialist

Stakeholders may include the KP Executive Vice President, Health Plan Operations and Chief

Growth Officer, who is in charge of the health plan’s marketing, sales, and services. Additional

stakeholders include the Director of the San Diego Director of Human Health and Services, Nick

Macchione, and San Diego Mayor, Todd Gloria. The consumers of the seminar, young adults ages 19-34,

will also serve as stakeholders in this project.

Evaluation

After the next enrollment period ends in January 2022, a web-based survey will be sent out to

participants of the Health Insurance Seminar. This survey will be prepared by the Project Manager. The

survey would ask participants to indicate if they enrolled in a health insurance plan. It will also ask

participants if they found enrolling in a health insurance plan easier because of the skills and knowledge

they gained from the seminar. If they have insurance, it will inquire if the insurance plan is private or

public, and if it is an individual or under a family plan. Lastly, the survey will ask participants if they have

a regular primary care doctor and if they had to utilize the emergency room in the last calendar year. If they
 HEALTH INSURANCE ENROLLMENT, EDUCATION, AND EMPOWERMENT 8

utilized an emergency room, the survey would prompt participants to list the reason(s) for the visit. The

results from the survey will then be compared to baseline data that participants gave upon enrollment to

the seminar.

Endorsements and Next Steps

The project is endorsed by Kaiser Permanente. Additionally, the project is endorsed by the San

Diego Department of Human Health and Services and the City of San Diego. Readers are encouraged to:

 Understand the various barriers that prevent young adults from obtaining health insurance.

 Recognize that a high percentage of uninsured young adults has drastic effects on other members

of society and the healthcare delivery system as a whole.

 Acknowledge the role of health insurance as a gateway to preventative services, which is often

underutilized by young adults.

Conclusion

Young adults are typically new health insurance consumers, and it is pertinent that there are

resources and programs available to them to teach them how to acquire health insurance. When young

adults lack insurance, they risk not having access to preventative care and cause further strain on the health

care system by utilizing emergency rooms for their health needs. It is important that the various barriers,

such as financial to simply the lack of knowledge, are overcome in order to help young adults obtain health

insurance. These barriers can be overcome as a result of the education. By educating young adults to be

responsible health insurance consumers, it benefits the entire health system as a whole.
HEALTH INSURANCE ENROLLMENT, EDUCATION, AND EMPOWERMENT 9

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