Young Professionals Go Without Health Insurance

HOLLY KERNAN: These days, fewer and fewer jobs provide health care benefits. And in this recession, jobs themselves have become scarce. These are some of the reasons why the face of the uninsured is changing. In California alone, nearly 4 million working people lack health insurance. Many of them are young, educated professionals who freelance or work part time. These are the invisible uninsured, our neighbors and friends. Often, lacking health care is their uncomfortable secret.

Over the next few weeks, we’ll hear some of the stories of this group – ranging from those who have lied to access health care, to those who live in fear of an illness or injury that would debilitate their bodies and their bank accounts. Today, KALW’s Zoe Corneli reports on educated young adults who make the choice to live without health insurance.

ANDREW HOFF: I was 25, in perfect health, I was an athlete. I’d never had anything wrong with me, so the idea of preventive care, having access to that was ridiculous to me, I shouldn’t have to pay for that if I didn’t need it. And I think a lot of 20-somethings think like that.

CORNELI: Andrew Hoff is 31 now. He’s the brother of a colleague of mine… He’s an aspiring writer, and pays the bills by tutoring school-aged students in math and English. But six years ago, he had just left a job doing research for UCSF and was soon to start another job running an after-school program.

HOFF: When I quit, they offered me COBRA.

CORNELI: COBRA allows you to keep your group health plan after quitting a job or getting laid off.

HOFF: But I took a chance, a calculated risk I guess, and assumed that I wasn’t going to have any health problems within this four month gap between my two jobs, so I elected not to get COBRA, because I woulda had to pay for it.

CORNELI: So you were a healthy 25-year-old guy, and you said to yourself, nothing’s gonna happen to me. I mean, what could possibly go wrong, right?

HOFF: Yeah, I mean, I had gone through 25 years of seeing a doctor – what, once every 5 years? I’d never had a major accident of any kind, so I was taking a risk, but I thought it was a well-calculated risk.

CORNELI: But something did go wrong. Hoff was riding his bike down Van Ness Avenue in San Francisco, when he looked over his shoulder to make sure he wasn’t too close to traffic…

HOFF: And when I did that, I went through this intersection. And I hit a pothole while I was still looking over my shoulder, so I was completely unprepared for this pothole, and when I hit it, I flew over the front of my bike, and landed basically, put out my hands and landed basically straight on my hands, and then my head scooped down onto the pavement and I got this big gash on my chin.

CORNELI: When he stood up, his arms felt numb. He decided to walk home and ice his elbows.

HOFF: So I picked up my bike, or you know, dragged my bike off the pavement rather, walked home, but by the time I walked home, I couldn’t even lift both my arms to my waist, they were basically dangling at my sides.

Once I got inside, I knew this was much more than a simple icing of my elbows, so I managed to call my older brother, and he came, picked me up, and took me to General Hospital.

CORNELI: Hoff had no income at the time. He knew uninsured patients went to San Francisco General, but he didn’t know how much he’d have to pay.

HOFF: Before I even got there, I was concerned about the financial aspect. … I had money saved up, and I thought that I was gonna have to tap into .. this reserve.

CORNELI: Hoff says his memory of what happened next is cloudy, because he was in a lot of pain. But he does remember that even though the ER waiting area was full of people, many of whom appeared to be homeless and mentally ill, he walked up to the intake window and was told he’d be seen right away.

HOFF: And lo and behold, literally like 2 minutes later, a doctor came out and took me into the back.

CORNELI: It turns out Hoff had fractured both his elbows. He received x-rays, splints for both arms, and painkillers. And, because Hoff didn’t have any income, the hospital’s sliding-scale payment system charged him a total of thirty-five dollars.

HOFF: The treatment I received there was top-quality, and my experience all-around was a good one. And so I don’t really understand, if this resource is out there for people, why get health insurance. (Laughs)

CORNELI: Hoff did get health insurance through his next job, but now that he’s self-employed, he’s uninsured again. If he were to have an accident now, he’d find the city’s health system has changed. The sliding scale payment system has been replaced by a so-called universal health program, Healthy San Francisco. The program costs more than 120 million dollars per year, paid for by a combination of city and state funds, participant fees, and employer contributions. Andrew Hoff feels secure knowing the city’s safety net will catch him in an emergency. Healthy San Francisco Director Tangerine Brigham says that’s not exactly the right response.

TANGERINE BRIGHAM: We encourage people in all our materials, on our website, that if you actually have insurance, you should not drop your coverage to enroll in Healthy San Francisco, that insurance is better for you.

CORNELI: That’s because the public program doesn’t include vision and dental coverage, and it only works within San Francisco’s city limits.

BRIGHAM: But, we also recognize, based on our eligibility, that maybe some individuals who cannot afford, or cannot acquire, or maybe their employers don’t offer health insurance, and Healthy San Francisco is really designed for that population.

CORNELI: Andrew Hoff says the only insurance he could afford would be catastrophic coverage.

ANDREW HOFF: Preventative care, insurance where I can have access to a doctor regularly, is just something I can’t afford right now, I’m on a pretty fixed income, so to have to pay this money for comprehensive health insurance on a monthly basis – it’s just not a reality for me right now.

CORNELI: But he recognizes that can’t last forever…       

HOFF: I don’t think I’m that naïve! (Laughs) I mean it can’t go on indefinitely, I know this… I mean it’s a very difficult question, because in many respects you’re gonna go on indefinitely until something happens, because it’s just not a reality. However if one is wise about it you should get – you should get health insurance now. But financially, if I continue on the way it is, it’s just not gonna, it’s probably not gonna happen.

CORNELI: Andrew Hoff is part of a generation that’s disproportionately going without health coverage. Young adults make up just 17 percent of the under-65 population, but about 30 percent of the country’s uninsured.

SARA COLLINS: So it’s important to look at this age group, why they’re having such difficulty gaining coverage.

CORNELI: Sara Collins is an economist with the Commonwealth Fund and a leading researcher on uninsured young adults. She says the reason so many young adults go without health coverage is not, in fact, because they think they’re invincible.

COLLINS: When they are offered coverage through their jobs, they take up at nearly the same rates as older workers do.

CORNELI: Collins says there are a number of causes – first, young adults are often kicked off of the health insurance they’ve had since birth.

COLLINS: In this age group, they lose coverage from their parents’ plans when they graduate from high school, or when they graduate from college.

CORNELI: Then, they often end up in the kinds of jobs that don’t provide health coverage – working part time, for lower wages, at smaller companies, or doing freelance work.

COLLINS: It’s also a microcosm of what’s really troubles the health care system right now. This age group has very loose connections to the labor force, they are moving in and out of coverage, because of the fact that our health insurance system is really based on … employers’ offers of coverage. So the likelihood of having insurance in the United States is linked to having a job that offers health insurance coverage.

CORNELI: Collins says it’s getting harder for all age groups to get health care through their jobs. And, she says, insurance on the private market is not only expensive, but also notoriously hard to get. Collins says all those young adults who don’t have regular access to a doctor may be setting themselves up for long-term health consequences.

COLLINS: We know that 15 percent of young adults have a chronic health condition like arthritis, asthma, diabetes. And the likelihood of having an injury-related visit to the emergency room is also highest in this age group compared to other age groups, so if you think about that in terms of their own health, and the costs to the system down the line, so we do need to make sure everyone has coverage, including young adults who are often perceived as healthy.

CORNELI: Congress is currently considering several proposals to overhaul the nation’s health care system. Collins says any of them, if passed, would significantly expand coverage for young adults. But for now, many 20 and 30-somethings still lack health insurance, and many of them live in areas that don’t have a safety net like San Francisco’s. To Andrew Hoff, that doesn’t make sense.

ANDREW HOFF: It strikes me as absurd, considering the fact that the rest of the industrialized world, more or less, has basic health care for their citizens. So the fact that we don’t, yeah, it’s somewhat shocking.

CORNELI: In San Francisco, I’m Zoe Corneli for Crosscurrents.

HOST: That story was produced as part of a California Endowment Health Journalism Fellowship. In the next installment in our series, the challenges of navigating the health care safety net.

WOMAN: You know, you can describe the frustration that you go through, having to go from one clinic to another, and how long it’s taking, but you actually have to go through the hell yourself to really experience the torture of just not getting the care that you need in a reasonable amount of time.