The number of youngsters without health insurance climbed again in 2006, so 38% of high school graduates and 34% of college graduates will spend some time uninsured in the year after graduation, a new report shows. According to the latest federal data, there were 13.7 million Americans aged 19 to 29 without health insurance in 2006, up from 13.3 million in 2005. Public programs such as Medicaid and the State Children's Health Insurance Program end coverage at the age of 19 and voluntary employer-provided insurance is tied to the ability to get a job, and the jobs available to youngsters tend to be those that don't carry benefits. While young adults are less likely to need health care, "they do use the health-care system," the report's co-author, Sara Collins said. "Losing coverage at this time can affect your ability to transition effectively into a situation of health care."

And when young people do require health care, it can be because of a major accident, in which costs can be "catastrophic," she said. "And it is never a good idea to be without health insurance, no matter what your age." Two-thirds of the young adults who went without health insurance for some time went without needed care because of cost, the report said. Half reported problems paying medical bills or said they were paying off medical debts over time. Some action is being taken to remedy the situation, Collins said. Twenty states have passed legislation requiring insurance companies to extend coverage of minors after age 18 or 19. The age limits in state laws range from 24 in Delaware, Indiana and South Dakota to 30 in New Jersey.

On the federal level, a law has been proposed which would have dependent children of government workers covered to age 25. Extending the age limit for federal programs such as Medicaid would have the greatest impact, because such programs cover poorer people, Collins said. "This is a problem facing people at all income levels, but the largest number of uninsured are in lower income families," she said. Raising the age limit for those programs would cover up to 7.6 million uninsured young adults in families who have incomes below 200 percent of poverty, the report said. States could help by having the colleges and universities which they fund offer insurance to students, both full time and part time, the report said.

The issue calls for a public-private approach, said Robert Zirkelbach, spokesman for America's Health Insurance Plans, a group in Washington, D.C., which represents 1,300 insurers covering 200 million Americans. The organization has made several proposals about better coverage for younger adults, including expansion of Medicaid to cover all members of a family, Zerkelbach said. "We need to make health-care coverage more affordable, that has to be done by reducing the underlying costs of medical care."