One Sick Fall

With health insurance out of reach, a generation braces itself for the worst

At age 22, Kristen Gass had minor outpatient surgery to remove pre-cancerous cells from her cervix. At the time, she was working as an actress and had health insurance through the Actors' Equity Association, a union that represents actors and stage managers working in theater. Soon after, she moved back home to Los Angeles, took a break from acting, and lost hercoverage. When she looked into buying a policy, insurers quoted monthly premiums hundreds of dollars higher than she was able to afford, citing her recent surgery and a family history of cancer. They told her she would have to be without symptoms or treatment for at least two years before premiums would drop. So she went without.

"I just didn't go to the doctor," Gass said. "I went once for a checkup and that was it. I realized how much it would cost."

Had she been in New York, the cost of individual insurance would have been the same regardless of her history. But she still couldn't have afforded it.

illustration: Jonathan Weiner

Only one New York insurer has posted a plan on eHealthInsurance, at a monthly premium of $280. The plan covers hospitalization but not doctor visits. According to the New York State Insurance Department, basic HMO plans start at $320 a month. The self-employed may be able to get insurance at group rates through organizations in their field. One of the more popular comes from the Freelancers Union—part of Working Today—which offers HMO coverage, including vision and dental, for $286 through Health Insurance Plan of Greater New York.

Just as race plays a factor, so does gender. By the time he reaches age 34, the average Joe earns $30,677, and could expect to pay 11 percent of that gross for the cheapest plan in New York. The average Jane, earning $21,649, would fork over 4 percent more.

If the cost of insurance is unbearable, so is the cost of not having it. Even common injuries can be financially debilitating for people still trying to get on their feet. Manhattan resident Drew Brown, uninsured and unemployed, went to the emergency room at Beth Israel for a toothache and left with a prescription and a $500 bill. Brooklynite Andrea Craig had to pay $2,000 for surgery to treat a mouth infection before she got insurance through her current job.

Some people have almost gotten used to it. "If I get sick, I go to the emergency room. I usually give them my real name. I get bills. If they are reasonable I pay them. If not—if they're, like, four or five grand—I ignore them," said a 35-year-old Manhattan photographer who refused to give his name. "The emergency room is the only place I go. It's the only place that's free."

High numbers of uninsured strain hospital budgets because emergency rooms can't deny care to those who can't pay, Harvard professor Blendon said. Disease outbreaks are worsened when a significant fraction of the population doesn't have insurance. "We've lucked out because we haven't had any big epidemics, but with SARS and anthrax it really struck experts that you are going to have people getting sick and not going to the doctor," Blendon said. "Canada didn't have that problem."

The only real fix is universal health care, said Ken McDonnell, and with the current political climate, he says, such a policy has "a snowball's chance in hell." Estimates of the cost range from a net savings to a new burden of trillions. A study published by the journal Health Affairs estimated that extending coverage to the uninsured would lead to extra spending on the order of $33.9 billion to $68.7 billion each year as the newly insured sought additional medical care.

Short of universal health care, most reforms still leave young adults at risk. For now, many go it alone, scrounging up care where possible and resigning themselves to the hope that lighting won't strike. After all, millions of people do it.

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