Most days,David Hanley tosses the collection agency notices that come in the mail.
When they call,he tells them they have the wrong number,hangs up or pretends he's not home.
“I don't have any money to pay them so I don't pay them,” said Hanley,a 20-year-old bicycle messenger from Stockbridge,Mich. “I don't even know if I'm going to pay them back. They can't really come after me and repossess my pills.”
The event that changed Hanley's lifestyle – and may ruin his credit – was when a Ford Taurus struck him on the road. The driver sped off with Hanley's bike stuck under the car.
Two hospital visits later,Hanley,who has no health insurance,had a $2,500 bill. “I didn't have a bike to make the money back,” he said. “And I didn't have the money to get the bike to make the money back.”
Hanley's case isn't unusual. According to 2002 Census data,more than 43 million people were uninsured during part of the year. Two-thirds are considered poor or near poor. Young people ages 19 to 24 are most likely to lack health insurance – nearly one in three is uninsured.
Their stories vary. Michael Fleming,a family physician in Shreveport,La.,said about one-fifth of his patients are uninsured young adults.
“Most frequently,they are people I know,” said Fleming,who is president of the American Academy of Family Physicians. “They tend to be students I've taken care of over the years. Suddenly they get out of school and maybe they're in their first job,which may not have insurance coverage,or between jobs. They're no longer covered on their parents' insurance.”
Some young adults lose coverage when they turn 19,the cut-off age for public programs like Medicaid and the State Children's Health Insurance Program. “Young workers are less likely than older workers to find jobs that include benefits,” according to a 2002 report by the Institute of Medicine. They are also less likely to earn enough to purchase insurance independently.
Although there is no research to prove it,many people tend to think young people are healthy and don't need much medical care. In fact,studies show young adults face a higher risk of serious injury,especially from car accidents and violence.
“It was almost like I was afraid to go to the doctor and hear bad news,” said Jonathon Jones,26,who spent four years uninsured in his early 20s. “I felt if I didn't go,it'd just go away and I'd eventually get better.”
During his time at the University of North Carolina,Jones often put off seeking health care. He delayed receiving treatment for eczema for two years,until he got health insurance.
Nearly half of the uninsured have postponed seeking care because of the cost,according to a 2003 report from the Kaiser Commission on Medicaid and the Uninsured. This means they're less likely to receive preventive screenings – such as mammograms and tests for sexually transmitted diseases.
But poorer health isn't the only consequence. Huge bills,debt and collection agencies can be scarier,especially to young people paying off student loans or looking for a job. Hanley had to move back in with his parents,where he is avoiding collectors and looking for a job that offers health insurance.
And young adults don't always know the consequences of not paying their bills. Collection agencies will turn cases over to credit bureaus – which can hamper someone's ability to take out a loan or get a credit card.
“It's sad on both sides,” said Gary Winston,a marketing director for National Credit Systems Inc.,a New York-based collection agency. “On one side you have people who can't afford to pay their bills. On the other side are people who are supplying their services and aren't being paid for it. Neither side is particularly happy.”
After spending about three years without insurance in her early 20s,Sarah Rigg learned “it never hurts to ask,‘I don't have insurance. Can you cut me a deal?'” Rigg,31,is the editor of a weekly newspaper in Belleville,Mich.,whose dentist and other health care providers granted her discounts.
Fleming said he frequently gives discounts or free service to the uninsured.
“Virtually every family physician is not going to turn someone away if they need help,” he said. But Fleming said he tells his young patients insurance “is something they need to get quickly.”
Students or recent graduates can often purchase plans through their universities or alumni associations. Visits to student health clinics are usually free or inexpensive.
Another option is short-term health insurance,which costs less than $100 per month. For the most part,these plans pay for care in the event of serious illness or injury but do not cover routine care.
Health savings accounts – which allow individuals to make tax-free contributions to a special account – are a new option,but they're tied to low-premium,high-deductible health plans. President Bush promoted HSAs,as they're called,at a discussion at the U.S. Chamber of Commerce Tuesday.
Young people have yet to establish themselves as a dominant force in politics,which means Congress has taken little action on issues that affect them – such as health insurance – some representatives say.
“I think that young people are underrepresented,” said Rep. Vic Snyder,D-Ark. “They don't vote as often. They don't have as much money to correspond with parties and form organizations.”
Snyder introduced a bill in September that would allow states to extend Medicaid and SCHIP coverage to low-income youths up to age 23.
“What has to happen is those of us who are older,we need to not forget about young folks,” he said. His proposal has 35 co-sponsors.
Last week the Ways and Means Committee Subcommittee on Health held a hearing about the uninsured,and members of health organizations asked Congress to look for a solution to the overarching problem of health insurance.
The likelihood of Congress taking up health insurance appears slim,however. Rep. Pete Stark,D-Calif.,one of the co-sponsors,summed it up: “Year after year we hold a hearing on the uninsured. Year after year the numbers continue to rise. And year after year we don't do anything about it.”