A “Young Invincible” needs health care after all

The nurse wheeled my young friend Alexander’s gurney into the emergency room.  As she walked away from him, she shot out a parting remark. 

“This is how you lose a leg – or your life.”

 Alexander, 23, lay face down on the gurney in the Verdugo Hills Hospital emergency room. His leg, impossibly swollen and bright red, caused him excruciating pain. Almost as bad, he was itching for more information. Would he die? Would he lose his leg? He felt remorse for not going to the doctor sooner and an intense, overwhelming desire to look up information about his unknown condition on his iphone.

He would later learn that he was suffering from a severe case of cellulitis, caused by a common bacterial infection of the skin that can easily be treated with antibiotics. Neglect did the damage, not a superbug.  It all started with a small rash about three weeks ago. But as his leg swelled, day by day, Alexander held off on going to a doctor.

He hadn’t been called in much for work lately at his $10-an-hour job and he was trying to avoid paying the $20 co-pay for a trip to a doctor. Alexander, who starts graduate school at UCLA in the fall, had no insurance through his employer. “I looked at the ledger I had made for the rest of the month and all the money I had left had the word ‘food’ written next to it,” he explained.  He also had a young man’s overconfidence that he could tough out anything. As he confessed to me Thursday morning, when it came to health insurance and doctor’s visits, “I kinda didn’t think I really needed it.”

Alexander’s right leg was saved and he was released Wednesday night from the Glendale, California hospital. He spent three days in the facility, with an IV pumping massive doses of antibiotics into his strapping 6’2” frame. His leg is still swollen and pockmarked with scars. He has a giant abscess caused by the festering massive infection. He’s very lucky to have his leg.

In wonk speak, healthy young people like Alexander are known as “Young Invincibles.” Historically, they have had the lowest rate of insurance of any age group in America.  They numbered nearly 14 million before President Obama’s Affordable Care Act went into effect, accounting for nearly a third of the overall uninsured population that health reform intended  to help.

Getting young people like Alexander into the health insurance pool is an essential element of health reform.  At the most basic level, getting this population insured prevents unexpected accidents or illness from bankrupting their families. It’s also important because these healthy individuals cost very little to insure. Their participation in a common insurance pool helps to offset the much higher cost of caring for the chronically ill.  Their participation makes the goal of near universal coverage more financially feasible. The mandate to purchase insurance – one of the most controversial provisions of health reform -- ensures that these usually healthy individuals are in the risk pool.  

Alexander has insurance today because of the Affordable Care Act. One of the earliest provisions to go into effect allows parents to insure their children on their plans until they turn 26. That provision, which went into effect in September 2010, has proved so popular that some insurance companies promised to continue it even if health reform was overturned. Today, like Alexander, nearly 6.6 million young adults have signed up for health insurance under this provision, according to a recent study by the Commonwealth Fund.

Because Alexander has insurance, he and his family were spared a devastating financial hit from his hospitalization. His bill for his three-day stay came to $10,500. His mother, who rushed here from out of town when he was hospitalized, was responsible for only a small portion: $250 for a co-pay plus her $450 airfare and three missed days of work. Of course, as she reminds him, it would have been a lot less expensive to pay the $20 co-pay for the doctor visit early on and then another $10 for a generic antibiotic.

As for Alexander, he’s not feeling nearly so invincible. On his first day home, and still recovering from nearly losing his leg, he’s grateful for Thursday’s U.S. Supreme Court decision.

“I was very happy,” he told me.” If anything else happens like this again, I want my mom’s insurance.”

Asked about the value of having health insurance, he adds ruefully: “It makes perfect sense to me now.”