One Foot In, One Foot Out: The Health Care Challenges Adolescents Face

25 Aug

Katherine Rogers is currently working on a PhD in Public Policy and Administration at the George Washington University, where she also received a Master of Public Health degree in health policy. She has worked in state health policy and in international alcohol policy, and her current work focuses on adolescent health. She also holds degrees from Cornell University and the University of Pennsylvania.

I taught high school a few years ago, and am lucky enough to keep in touch with some of my former students. Often when visiting Philadelphia, where I taught, I meet up with a few of them for lunch. On one such occasion, the kids asked what I was studying in school, and so the conversation turned to health policy and insurance coverage.

A few of them were enrolled in Pennsylvania’s State Children’s Health Insurance Program (CHIP) coverage. But one of the kids, Melissa, reported that while she had enrolled her young daughter in CHIP, she herself had no insurance coverage.

Melissa was still young enough for CHIP coverage herself – but remained unenrolled and seemed completely shocked at my suggestion that she sign up. Medical personnel at the hospital where she had her baby gave her plenty of information about how to enroll her child – but nothing about what to do for herself.

I think this highlights some of the problems we face in shaping health policy to best serve adolescents. Teenagers and young adults – from age 14 all the way up to age 25 – face some unique health challenges but aren’t always targeted for health policy or health interventions. Mortality rates among teens ages 15 to 19 are more than four times as high as those among children ages 5 to 14. One in every four American teens has a sexually transmitted disease, and one in five has a diagnosable mental health condition. And some 750,000 girls aged 15 to 19 become pregnant every year.
But adolescents remain uninsured at higher rates than younger children and are less likely to be enrolled in government health insurance like Medicaid. And if Melissa’s experience is any indication, adolescents may be getting short shrift compared to younger children and infants.

What can we do to fix that? If the main drivers behind current health reform efforts are reducing the number of the uninsured and making health care more cost effective, adolescents are a prime target for those efforts.

Perhaps simple improvements in outreach could help. Encouraging staff in hospitals and schools to provide young people with information about their insurance choices and other health care access options educates adolescents about where they can go and who to ask for help.

But we also have a couple larger options that might create a more adolescent-friendly health policy environment, one in which it is harder for kids to go without insurance and easier for kids to access services. We can expand coverage upward – in CHIP to a later age, like 21, or in private insurance by incentivizing riders to allow young people to stay on their parent’s employer-sponsored insurance. We can also encourage or even require greater coverage of more cost-effective preventive care, like contraceptive education or substance abuse prevention programs.

After our lunch, Melissa emailed me within a week to tell me she had investigated her insurance options and applied for CHIP coverage through the state website I suggested. Perhaps through health reform, we can eliminate situations like Melissa’s – and make health care and coverage easier to access for adolescents nationwide.

– Katherine Rogers

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Posted by on August 25, 2009 in Uncategorized


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