By Brian Wolly
Keith Brooks, a 22-year-old journalism major at the University of Kentucky, has not had health insurance for the last three years, but that fact doesn't keep him up at night.
"In all honesty, I've never really thought about [health care]," he said. "I haven't been sick, so I haven't had to use it."
Brooks' situation is not unusual. Adults between the ages of 19 and 29 make up the fastest-growing group of uninsured Americans, according to a 2006 study by the health policy research foundation the Commonwealth Fund. Nearly a third of these young adults -- more than 13 million people -- are uninsured.
Age limits in coverage
The age at which young adults lose their health insurance varies -- often by their or their parents' socioeconomic status.
Teenagers from families covered by Medicaid or one of the State Children's Health Insurance Programs lose their coverage at 19, when the government considers them adults. According to the Commonwealth Fund report, 54 percent of young adults living below the federal poverty line are uninsured, and 42 percent of young adults living just above that level are uninsured. Overall, 70 percent of the uninsured in the 19-to-29 age group come from families living in poverty.
On the other hand, young adults who are covered under their parents' employer-provided plans can usually remain covered until they turn 23 years old -- as long as they attend college. Nearly 60 percent of employers will only insure their employees' adult dependent children if the children are students, according to the Commonwealth Fund study.
So, much as the income gap between college graduates and high school graduates has increased in recent years, a similar chasm is emerging in health care coverage. According to the Agency for Health Care Policy and Research, nearly 78 percent of full-time students have health insurance, while only 46 percent of young adults who are not students are covered.
Of course, not all students have coverage either. Brooks started his collegiate career at Ohio State University, where students are required to show proof of health insurance or subscribe to one of the school's plans. For the 2006-7 academic year, the premiums for OSU's comprehensive plan are $683 for one semester; the basic plan costs $187 per academic year.
But at Kentucky, there is no health insurance requirement. "I just really prefer not to pay any sort of amount until after I graduate," said Brooks. "I'd rather be covered fully. [The basic plan] doesn't cover you for hospital stays, so it is pretty limited."
Ryan Speaker, a 21-year-old senior at Colorado State University, also opted out of a health insurance plan because of the cost. Although he looked into subscribing to his school's plan, he considered it too expensive at $650 a semester, and not nearly comprehensive enough to meet his expectations.
"My situation is -- that $650 I need for rent and food and things I need to live," said Speaker. "It's either an extra month of rent, or accidental coverage. I try to be mindful of washing my hands during flu season and do the preventive things I can in the meantime."
Once students graduate, meanwhile, they face a new potential set of challenges: low-paying and short-term jobs that may not provide health insurance. Young adults frequently go without health insurance for months at a time once they are done with school, according to Sara Collins, the assistant vice president of the Commonwealth Fund.
"The likelihood of being covered is the probability of getting a job," said Collins. "The fastest growing uninsured rates are among the 23-24-year-old recent graduates. ... It's a very transitional part of life where you are in and out of different places."
Brooks acknowledged this new reality, saying that he would like to have coverage when he gets a job, and "it'd be unfortunate if they didn't offer any sort of plan," however, "it wouldn't be a deal-breaker."
Public and private efforts
Recognizing a growing problem, private health insurance companies have in recent years begun to develop less expensive health insurance plans to cater to young adults.
Two years ago, Wellpoint, a health network associated with the Blue Cross Life and Health Insurance Co., conceived the Tonik health care plan, an individual plan targeted to young adults.
Jude Thompson, the president of individual products at Wellpoint, said that his company's research found "young invincibles" and "mature mavericks" were an untapped market of the uninsured. Seventy percent of eventual Tonik subscribers were previously uninsured.
"Younger people really wanted to say 'let me see the benefits, find out if this is a good value,'" said Thompson.
Currently available in six states, Tonik's Web site offers three levels of coverage, for the "thrill seeker," the "part-time daredevil" and the "calculated risk taker." Elsewhere on the site, there are details of the costs of various emergency procedures, from a burst appendix ($48,151) to an air lift ambulance ($8,928) to "You landed wrong. Really wrong" -- which in Tonik-speak means a fractured ankle, and a compound fracture of the tibia and fibula ($101,790).
Thompson described his company's pitch to young adults as almost as important as the actual content of the plan. "If you have a person who hasn't had much more than a cold in your life, [you] have to make sure they understand the true cost of this product."
On a government level, some states have looked to lower the number of young adults who are uninsured by raising the age at which parents' insurance plans can drop dependent children. New Jersey, for instance, implemented a law in 2006 that extended the age of dependency to 30. Other states, including Massachusetts, Colorado and New Mexico, extended the age to 25 in laws that allow even non-students to remain on their parents' plans.
According to Sara Collins at the Commonwealth Fund, most of the plans raised as a national solution to the uninsured problem contain provisions for this demographic. For example, Sen. John Kerry, D-Mass., introduced a bill specifically aimed to extend the age of dependency to 20, and Rep. Vic Snyder, D-Ark., and Sen. Blanche Lincoln, D-Ark., coordinated a bill to extend the age to 23.
Το άρθρο του Brian Wolly δημοσιεύτηκε ηλεκτρονικά στο πλαίσιο έρευνας με θέμα "Οι ανασφάλιστοι των ΗΠΑ" (The Uninsured in America) που παρουσίασε το Online News Hour του PBS.