Anybody who works with adolescents knows that the transition into “young adulthood” can be a time of tremendous change. Young adults move, start and finish school, gain and lose jobs. These and other life changes can trigger a loss or change in health insurance coverage (churning) for young adults. At the same time, access to care matters during young adulthood when health problems can arise related to reproductive health, mental health, and substance use. Researchers at the University of California, San Francisco (UCSF) conducted case studies with young adults ages 18–32 in California who recently went through changes in health insurance status to understand their experiences and the type of support they need to ensure seamless access to health care.

Young adults in this study explained how changing insurance limited their engagement in the health care system and contributed to unmet health needs. Young adults noted the obvious: health care is complicated. They expressed confusion about how to access and use health insurance, especially if they recently moved, changed between public and private insurance systems, or had limited help with insurance from family members. One college student shared her struggle connecting with a doctor after moving to a new city:

“I think that this whole area of life is very vague for a lot of people, which is kind of crazy to me because it’s so important. I don’t even know what to say [about health insurance] because I don’t know what I don’t know.”

Young adults expressed that they need more dynamic skills to navigate and self-advocate within a changing health care system. They also need greater access to comprehensive health insurance and health care resources. One 22-year-old interviewed shared:

“If there was an ‘Adulting 101’ class, that would be great. There’s taxes, there’s health insurance, there’s how to buy your first car, how to build up credit, even how to budget. It’s one paint brush stroke at a time that’s going to give you the whole picture, you know?”

In the midst of the national debate over health care reform, these interviews ask us to prioritize the “user experience” of young adults navigating the health system with emerging independence. How can we help adolescents and young adults prepare to confidently navigate health care during periods of life change?

Please read their stories and ideas in this research brief from UCSF here, along with an infographic on churning using data from the 2014-2015 California Health Interview Survey (CHIS).

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