Young, happy -- and uninsured
Aug. 29, 2003

By MATTHEW RODRIGUEZ
Observer-Dispatch

On weekdays, Tina Zysk, a registrar with Faxton/St. Luke's Healthcare, calls and asks patients for a few bits of basic information -- name and insurance company -- so they can bypass registration upon arrival.

Shuffling paperwork across her desk, Zysk admires the different types of coverage.

Unlike most of the patients, Zysk does not have health insurance herself.

A full-time employee at the hospital, she is waiting for employment-based health insurance to kick in following a limited probationary period, she said. She lost her parents' coverage in April after graduating from Thomas R. Proctor Senior High School in 2002.

Young, 19, and uninsured, Zysk is not alone. About one quarter of Generations X and Y -- young adults between the ages of 18 and 34 in the United States -- do not have health insurance, according to a 2002 U.S. Census Bureau report.

For individuals like Zysk who lack health insurance, it is an additional burden if they become ill. In large groups, the effects can be catastrophic.

For example, about half of the nearly 200 burn victims -- mostly young adults -- who were injured in the fatal West Warwick, R.I., nightclub fire on Feb. 20, did not have health insurance, said Jane Hayward, director of the Rhode Island Department of Human Services.

"There is a category of young people who, when they hit 18, they're largely on their own," Sen. Hillary Rodham Clinton, D-N.Y., said in a telephone interview. "When they are ill or if they have an injury, it's often devastating."

According to U.S. Census Bureau data prepared for the Observer-Dispatch, nearly 1.3 million young adults in New York state between the ages of 18 and 34 do not have health insurance. That's roughly 29 percent.

"The number is slightly higher in New York," Clinton said. "This is a problem that affects nearly a third of our young people."

For young people of color in New York state, the numbers are even more dramatic -- 45 percent of Hispanics and 39 percent of blacks are not covered, according to the data.

While reasons vary as to why many young people remain uninsured, the costs are clear.

When uninsured young adults become ill, prescription drug costs can rack up quickly. And, because some are unable to afford expensive emergency room visits, hospitals lose revenue that is difficult to recover. That is one factor driving up the price of insurance for everyone.

"If everybody were in the insurance market, actually, the cost would go down," Clinton said.

According to Andrew F. Biernat, vice president of Meridian Group of New York, the basic premise of insurance is to spread risk. So why are many young adults assuming all of the risk themselves?

"We were all young once," Biernat said. "You feel invincible."

Risk versus rising costs

Young adults, faced with rising insurance premiums, often substitute other benefits such as more money in their paychecks -- even at businesses that offer insurance, said Elliott Shaw, director of government affairs for The Business Council of New York State.

"What doesn't get through to young people when it comes to health insurance is that they're one unfortunate incident away," Shaw said. "There's got to be a greater understanding of the potential risk."

While he does not believe that young employees should be required to purchase health insurance, more can be done to entice them, Shaw said.

Still, many young adults believe health insurance is unnecessary precisely because they are healthy, according to studies done by Excellus Blue Cross Blue Shield Utica Region.

And, according to the studies, the rising cost of health insurance is another reason why so many avoid purchasing coverage.

In particular, the cost of employment-based health insurance, which covers nearly two-thirds of all Americans, rose dramatically in 2001.

The average price of such insurance jumped by its largest margin since 1990 between the spring of 2001 and the spring of 2002 as monthly premiums rose nearly 13 percent, according to a summary of findings released by The Kaiser Family Foundation and Health Research and Educational Trust.

According to Biernat, insurance costs are rising because of factors such as new medical technologies, an aging population, government legislation and state mandates, and doctors' malpractice insurance.

"It's not any one entity that can be put to blame," Biernat said.

Although employers still foot much of the bill, employees could expect to pay more each month. And additional deductions from a paycheck can be a turn-off to many young adults still struggling to establish themselves.

Lost in the shuffle

Young people can stay covered on their parents' insurance until they reach a certain age or they graduate from college. However, if they don't find employment soon thereafter, they can go for extended periods without coverage.

When they do find work, employer-based coverage often doesn't take effect until after a probationary period that can range from 30 to 90 days.

Zysk, who is eligible for employment-based coverage on Monday, is now counting down the days -- and crossing her fingers.

"I figured I would just stick it out until I got insurance," she said.

Zysk had pneumonia during the winter, and now she gets sick every couple of months, she said. She hasn't, however, been able to visit a doctor because of the potential bills.

"I have to guess what's wrong from prior sicknesses," she said.

Zysk said she pays about $300 per month toward her rent, car payments and auto insurance.

"I don't have the extra money to spend $300 on insurance," she said.

Indeed, coverage during periods of transition is difficult to find.

The best bet, according to local independent broker Peter Carchedi, is continued coverage under the Consolidated Omnibus Reconciliation Act of 1986 (COBRA).

COBRA is limited and takes effect under conditions such as death of a spouse, divorce, termination of employment or loss of dependent status, Carchedi said.

"(Young adults) have to be cognizant of the fact of that 60-day break between coverage," he said. "There's not gonna be anyone knocking on their door saying, 'You're not covered,' until it's too late."

COBRA, in the Utica area, typically runs between $200 and $300, depending on the company, Carchedi said.

And COBRA costs are high because people can owe up to 102 percent of their health insurance costs -- a significant portion of which was previously paid for by an employer, Meridian Vice President Biernat said.

"COBRA is not affordable," state Assemblywoman RoAnn Destito, D-Rome, said. "COBRA can be extremely expensive."

Falling through the cracks

While Medicaid covers those persons at or below the poverty level, and state-funded programs have increased low- and moderate-income coverage, others feel left out because they simply earn too much to qualify -- but not enough to pay for insurance themselves.

New York Mills resident Julie Howarth, 23, said her application for Family Health Plus was rejected because she made $80 too much during the month she applied.

In her search for health insurance, Howarth has been unable to find a plan between $0 and $200 either that she is either eligible for or that she can afford.

"There might be one out there, actually, that I'm qualified for," Howarth said. "But I haven't found it."

Not having health insurance has "put a lot of pressure on," she said. And, when she does get sick, she wonders if it could have been prevented.

Howarth had bronchitis and strep throat in late 2002 and a bacterial infection in June. She paid about $50 each time for doctor's office visits and close to $100 each time for antibiotics -- out of her own pocket, she said.

"Maybe if I'd had a glass of orange juice every morning or something I wouldn't have gotten sick," she said.

"I think there's a gap," Destito said. "We do need to provide a basic form of health care, of health insurance, to all of our working citizens."

The state offers Family Health Plus, a program for working adults who are unable to obtain health insurance through their employers, said Robert Kenny, spokesman for the state Health Department.

The program has enrolled more than 267,000 people since it began in October 2001, Kenny said.

"It's a grassroots approach through outreach," Kenny said.

Destito said the state's Family Health Plus program has been a success, albeit a costly one. She would like to see a similar program at the federal level.

More than 1,500 people have enrolled in Family Health Plus at the Mohawk Valley Perinatal Network, which is among the organizations that do outreach in Oneida and Herkimer counties, Executive Director Lorraine Kinney-Kitchen said.

"Our goal is to send a complete packet out of here so the (Social Service) workers can just say, 'Yes, this person is eligible,'" Kinney-Kitchen said. "(But) we constantly struggle to get the word out."

Looking to the future

Insurance companies are continually brainstorming new ways of reaching healthy young adults. The pool is, after all, supported by those individuals who do not require services exceeding their premiums.

"We don't like to see people fall through the cracks," said Jeff Flood, regional vice president of communications for Excellus Blue Cross Blue Shield Utica Region. "So if you look at what the state makes available and slide over into everything that we make available, our hope is to cover everybody."

But finding a supplemental plan, he agrees, can be a difficult process.

"It's something that requires a lot of work," Flood said. "They can't just expect to fall into something quickly and right away."

Recently, there has been a nationwide shift toward preferred provider organizations (PPOs), which could also help entice young adults, said Mark Ruszczyk, vice president of sales for Excellus Blue Cross Blue Shield Utica Region.

PPOs offer cheaper premiums while assigning more cost to individuals' co-payments for doctor's visits and prescription drugs.

"So if you are a young adult who needs coverage or really wants to ensure yourself against the risk of having a major health crisis or anything else like that, those programs are perfect," Ruszczyk said. "Frankly, it's kind of the best of both worlds."

And organizations such as Excellus Blue Cross Blue Shield continue to reach out to young adults. A billboard on the Arterial depicts a young woman in workout clothes drinking bottled water and reads: "Even when you're healthy."

But for young adults who have chronic health problems, the pressure is greater.

Days away from insurance eligibility, Zysk is taking her daily medications as needed in order to conserve. On Monday, thanks to her employer, she will be eligible to leave New York state's young and uninsured population.

Now, she hopes her healthy friends can find coverage, too.

"You never know what's going to happen," Zysk said.