Growing number of young people can't afford health-care coverage

Amy Choma looks forward to the day when she can visit a doctor and not worry about the out-of-pocket expenses it will mean, and the things she won't be able to afford as a result, such as taking in a Saturday matinee or spending a night out with girlfriends.

"My parents have passed away, so I'm taking care of myself," said the University of North Alabama student. "It's all I can do to cover my cell phone bill and pay for food and living expenses. There's no way I can afford health insurance right now."

Choma is among the growing number of uninsured people between the ages of 19 and 29 in the United States. An update by The Commonwealth Fund indicates that 13.7 million Americans in this group don't have health insurance; that's up from the 13.3 million in 2005. Further, 38 percent of high school graduates who don't attend college and 34 percent of college graduates will spend some time uninsured in the year after graduation.

"Lack of coverage and access to health-care services puts the health of young adults at risk, and can subject them, as well as their families, to potentially dire financial circumstances," said Sara Collins, co-author of the report "Rite of Passage? Why Young Adults Become Uninsured and How New Policies Can Help." She also is vice president of The Commonwealth Fund, a private foundation that aims to build better access to health care for low-income people, the uninsured, minority Americans, children and the elderly.

The report went on to say that two-thirds of young adults who had spent time without health-insurance coverage in the past year had, like Choma, done so because of the cost. One-half reported problems paying medical bills or were paying off medical debt over time.

Without the benefit of insurance, Choma has relied on the free medical services offered at the infirmary at UNA when a health crisis arises. The 21-year-old takes medicine to treat her anxiety, and she can't be without an inhaler to treat her asthma, a condition she said was only recently diagnosed.

"I've probably had it for years, but, in high school, I couldn't afford to go to the doctor, so I didn't know why I would be wheezing when I finished running," she said.

It's a story that's all to familiar to Cindy Wood, director of university health services at UNA, where she estimates as much as 40 percent of the student population of more than 7,000 is uninsured.

"There are all kinds of reasons for it - maybe they've never had health problems, maybe they don't have the money - but it's especially true of the young men. They think they're invincible," Wood said.

But there's only so much the infirmary can do, and local hospitals, including Eliza Coffee Memorial in Florence and Helen Keller in Sheffield, often treat students who come to their emergency rooms once the free campus service closes.

As public hospitals, neither can turn people away who are uninsured, but recouping those costs from their self-pay customers is something of a losing proposition, according to officials at both facilities.

At ECM, for instance, the hospital has paid out more than $16 million in services this fiscal year, which will end June 30. Patient accounts manager Dave Davis and business office director Diane Myrick hope to get 7 to 10 percent of that back, but the reality is that the hospital will probably see more like 4 percent of a return on its investment.

"When you're young and healthy, and, maybe you've never had a lot of medical bills, so you take a chance, and you go without insurance," Davis said. "By the time people are in their 30s and have had kids or are established in their jobs - that's often when they'll pick up health insurance."

Many young adults lose coverage between the ages of 19 and 25 as a result of being dropped from their parents' policies or from public programs such as Medicaid and the State Children's Health Insurance Program. Young adults from low-income households, however, are at even greater risk of living without insurance. In fact, 72 percent of the 13.7 million uninsured live in homes where the income is below the poverty level.

Ethan Slavin, spokesman for Aetna Insurance, said it comes down to priorities.

"People in this age group often have a number of competing financial interests, such as rent, student loans and credit card debt," he said. "If they are healthy, they may think that health insurance is not a necessity and consider that money expendable income."

In the face of these challenges, new efforts on the state and federal levels to cover young adults are gaining momentum.

Twenty states have passed legislation requiring insurance companies to extend dependent coverage to young adults older than 18 or 19. The new age limits range from 24 in Delaware, Indiana and South Dakota, to 30 in New Jersey. Additionally, a bill pending in Congress would extend health insurance to dependent children of federal workers to age 25.

Deanna Powers, a senior at UNA, approaches her 22nd birthday with trepidation simply because, without a job that offers health-care coverage, it will mark the last day she'll be under the umbrella of her parents' policy.

"We've looked everywhere for something I can afford, but, as a student teacher in the spring, I can't do that and have another job just to pay for insurance," she said. "I don't know what I'm going to do then, so I've had all kinds of visits to the doctor and dentist in case I can't afford to go later on."

UNA does offer students a $100-a-month policy through the American College Student Association, but, for those outside the college environment, the options for health insurance are slim and expensive, Myrick said.

"Blue Cross/Blue Shield is the primary private-pay insurer in the state, and they have an initiative to offer people better rates, but it's still not very affordable," she said. "And, it's often misleading because it's more of a discount plan and not really health insurance."

One thing national providers have done, however, is develop short-term plans for people like Powers, who need something in the short-term.

"You buy one to six months of coverage, and you can reapply for another six months," said Ellen Laden, public relations director at Golden Rule Insurance Co. "It's short-term health insurance, and it's designed to bridge the gaps in coverage between two longer-term plans."

New graduates, those aging out of their parents' policies, part-time students working part-time jobs and new employees not eligible for company plans are best suited to these policies, Laden said, adding that others, including those with pre-existing conditions and severe medical conditions, wouldn't qualify.

Even state governments offer little opportunity for help to their uninsured residents.

The possibility that the Alabama branch of the Centers for Medicare and Medicaid Services would be able to alleviate the problem among low-income uninsured young adults isn't likely.

"We've already seen the problems they have with reimbursements, and we know medical costs aren't going to get covered for free," said Bill Anderson, chief executive officer at Keller. "Someone has to provide insurance, and it could be the states' job to do that, but, when it's a bad economic year, like it is now, their ability to do that is diminished."

He, like Collins, say the number of uninsured adults may continue to rise as the sluggish economy makes having insurance more of a luxury.

"It happens in every recession - people lose their jobs, things get tight," Anderson said. "When the economy improves, you'll likely see more jobs and more health insurance coverage."

Michelle Rupe Eubanks can be reached at 740-5745 or michelle.eubanks@timesdaily.com.