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Uninsured Young Adults Take High-stakes Gamble

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The Dallas Morning News


DALLAS - Clint Bowers had always been in perfect health.

So when the 24-year-old Baylor graduate was dropped from his family's insurance plan and couldn't land a job with health benefits, he took a gamble.

He did without.

Then four months ago, Bowers got the shock of his life. Suffering from a fever and fatigue, he went to see his doctor. The diagnosis: leukemia.

"This is something you can't ever believe would happen to you," said Bowers, who went through three months of treatment before finding a way to get coverage. "I hadn't ever been sick in my life, and while I'm uninsured, I get hit with this."

In the United States, the number of people between the ages of 18 and 34 without health coverage has grown to 17.9 million people, accounting for 41 percent of the country's uninsured. Amid a soft job market and increasing insurance costs, experts fear that more and more people in this age bracket will forgo medical care.

"The facts are, the younger you are, the less likely you are to have a serious illness or need hospitalization," said Len Nichols, vice president of the Center for Studying Health System Change in Washington, D.C. "It is in some sense a rational bet, but it's a gamble, in capital letters."

"According to the most recent census data, 15.2 percent of the U.S. population, or 43.6 million people, are uninsured, up from 41.2 million in 2001. The number of people without coverage has grown steadily since 2000, coinciding with a struggling economy and a weak job market. Most young adults are dropped by their parents' insurance at age 19, or 22 if they go to college. In the last year, young adults made up 50 percent of all new uninsured cases. And studies indicate half of high school graduates who don't go on to college and two of five college graduates will spend time without insurance during their first year after graduation.

Most of them, when they consider the costs and what they'll have to give up, choose not to buy it," Nichols said. "They're betting against the probability that a very bad event happens to them."

Sarah Walker, a 23-year-old graduate student at Southern Methodist University, became ineligible for her parents' insurance when she turned 22. With a part-time job that doesn't offer benefits and a slew of other expenses, she says health insurance doesn't fit into her budget.

"I'm paying for my education, for rent, for food and for car insurance," she said. "All that comes before health insurance."

Sara Collins, senior program officer with the Commonwealth Fund, a health policy foundation in New York, said this age group is high-risk and needs to be insured. Young adults have the highest number of annual visits to emergency rooms and account for one-third of new HIV diagnoses. There are 3.5 million pregnancies among women in their 20s every year.

"It's a time when you're becoming an adult, and you need to establish your own connections to the health system," Collins said. "If you're losing coverage at this time, it's very difficult to establish those relationships."

Emily Childers, an accounting graduate student at Southern Methodist University, went uninsured until last summer, when a bad car crash forced her to reconsider. Though she walked away from the accident, she knew she might not be so fortunate next time.

"I realized if something had happened to me, I might be paying for it for the rest of my life," she said.

Rob Guilbert, corporate communications vice president with Fortis short-term health insurance, said the cost of medical treatment can be crippling. According to Parkland Memorial Hospital, a case of appendicitis can cost almost $9,000; the average broken arm costs $1,450.

"They don't realize that a broken leg, a car accident, or even an illness could wipe them out financially," Guilbert said. "At a time when they are trying to start off on the right foot, and get a good job, they could be put under huge debt for many years."

Young adults say they understand this risk. Although they have grown up insured and are told by parents to stay insured, once the responsibility falls to them, many say, they feel a degree of invincibility.

When it comes to purchasing insurance, the biggest obstacle is cost. Nichols said the price of coverage is rising faster than income, making it difficult for young people to get access to insurance. Some companies have even ended employee benefit plans, he said.

The best bet for young adults - second to working for a firm with benefits - is to purchase insurance in the non-group market, Nichols said. There, healthy people will pay around $150 a month. People with pre-existing ailments could pay up to $10,000 a month for coverage, he said. COBRA, a federal program that enables people to buy insurance from former employers or their parents' plans, costs around $3,000 a year for an individual and $8,000 for a family, Nichols said. And short-term emergency insurance, which protects only against catastrophic events, ranges in price by state.

Universities often offer their own coverage plans for undergraduate and graduate students. At SMU, the university policy costs $925 a year for healthy students. Those with pre-existing conditions have to pay out of pocket for related expenses for 12 months before full coverage kicks in.

"If you're healthy and test clean on all the big markers, then you can get insurance reasonably priced," Nichols said. "The danger with any of these is, if you have a problem, they're going to mark you up for it."

Christie Donahee, a 23-year-old enrolled in massage school, said she took the uninsured risk until her boyfriend, Bowers, learned he had leukemia. She has since purchased short-term emergency insurance, which is costly and does not cover the doctors' appointments and medicine needed for her attention-deficit disorder.

"Prescriptions that used to cost me $5 a month are now costing me $500 a month," Donahee said.

Donahee said that for now, her parents are helping her cover the cost, but that she wants to get new coverage as soon as she graduates.

Elaine Wethington, professor of human development at Cornell University in New York, said it is common today for parents to support their children into their mid-20s. She said that 50 to 60 percent of Cornell students go back and live with their parents after graduation, and that parents are being forced to pick up costs that employers used to cover.

"Parents expect that their financial contribution to their children will continue for another three to four years after graduating from college," she said. "We have seen this trend over the last 10 years, and it is a phenomenon that has accelerated in the last couple of years because of the economy."

Laura Childers, a 24-year-old public administration graduate student at Sul Ross State University in Alpine, Texas, was dropped from her father's plan a year and a half ago. Faced with the responsibility of buying her own insurance, she decided to wait until she could afford it.

"You just have to hope - that you don't get in a wreck, that you don't have to have surgery, that your body holds out until you get insurance," said Childers, Emily Childers' sister. "You're young, and you think you should be OK for a while."

Childers said she goes to her university doctor only when she is very sick or needs a prescription. This is common among uninsured young people, who, research indicates, go to the doctor less often and later in their illness. The uninsured tend to go to public clinics and public hospitals, while students turn to university health services to keep costs down.

Childers has been healthy so far. But her classmate, 27-year-old Amy White, hasn't been as fortunate. A university doctor examining White detected what she thought was an ovarian cyst during a routine checkup last year.

"I asked her how much a sonogram cost and she said $400," said White, who has been uninsured for five years. "She said I needed to have it, but I didn't have the money."

A year later, White not only had a sonogram - she had surgery. After she paid $1,500 out of pocket for X-rays and lab work, the county hospital helped arrange coverage under a low-income insurance plan. Doctors removed a 7-pound cyst.

"Since I was young, health insurance had always been taken care of for me," White said. "I guess I didn't know how to do it."


Collins said most young people do understand the benefits of insurance. When they are offered coverage from their employers, they take it at nearly the same rate as older adults, she said.

She said the reforms necessary in the health system include extending eligibility for dependents and those on Medicaid through age 23, and requiring colleges and universities to offer coverage to all students.

Bowers said when he first learned of his illness, the prospect of soaring medical bills was daunting. Friends were already planning fund-raisers when Bowers' mother, a schoolteacher, got him back on her coverage plan by paying a high premium.

With everything he has on his mind, Bowers said, obtaining insurance shouldn't have been an added fear.

"If I could go back, I would obviously have gotten insured," he said. "Having some, any kind, is much better than having none."


(c) 2003, The Dallas Morning News. Distributed by Knight Ridder/Tribune News Service.

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