Young adults, too, often find themselves in an insurance coverage limbo. An earlier Fund issue brief by Sara Collins and colleagues found that substantial churning in young adults' insurance coverage is a result of changes in their eligibility for public or private insurance as well as graduation from high school or college.^(16) (17) In a May 2005 update of their analysis, the authors showed that coverage in this population continues to deteriorate: the number of uninsured young adults climbed by more than 2 million from 2000 to 2003.

Policy options presented in the brief formed the basis of a bill introduced by Representative Vic Snyder (D-Ark.) to give states the option to increase the age limit for Medicaid and State Children's Health Insurance Program from age 18 to 23.⁽¹⁸⁾ Another option in the brief—that insurance companies be prohibited from writing policies that exclude dependents under age 26—was enacted by the California legislature but not signed into law.⁽¹⁹⁾

The program is also supporting research on the administrative cost burden stemming from the nation's fragmented system of health insurance coverage. Because providers care for patients insured by various private and public plans, they must contend with multiple payment schedules, claims forms, credentialing requirements, and other regulations. Such complexity creates excess transaction costs as well as barriers to improving quality of care. The Fund and the Robert Wood Johnson Foundation are funding research to measure the scope of the problem, identify sources of the highest costs, and propose public and private remedies to reduce administrative burdens. In related work, grantee AcademyHealth is conducting case studies of health care organizations' efforts to reduce administrative complexity.