Friday, February 22, 2008

Health Care and Young Guns

The Associated Press reported this month that there are over 13 million Americans in the age bracket of 19 to 29 that are not insured. They have no health coverage. There are a variety of reasons for this. Some of these in the under-30 crowd have never had any major health issues and feel they will not need insurance for now. Quite a number of them are just getting a start in careers and may not be able to afford insurance, or they may work for businesses that do not offer insurance benefits, or perhaps they are part-timers and do not qualify for employee sponsored health plans. Yet, there are even some of this group that take their health for granted as one of the "invincibles."

Small companies also contribute to the problem. People who work for small businesses are the least likely to get health care coverage from their employers. Forty-one percent of small businesses (3-199 workers) do not offer health benefits to their employees according to research published by the Kaiser Foundation. Obtaining eligibility may also be challenging for younger workers. The Institute of Medicine reports that the drop-off in employer-based health insurance for younger adults nationwide is traced primarily to a lack of eligibility and not whether young adults pay for insurance according to a study they released. The lack of health insurance for younger workers may be less associated with their willingness to pay and more associated with their employer’s ability to offer health insurance. Cost of premiums is one reason employers do not offer health insurance. Also, the inability of low-wage employees to contribute to the premium has been cited as another reason.

FierceHealthCare noted the study by the Commonwealth Fund by reporting that many get dropped from their parents' health insurance or public coverage for children when they turn 19 or graduate from college. And when they enter the working world, young adults often settle for low-wage or temporary jobs without health benefits. This lack of coverage puts their health at risk, and it can add financial stress to their lives just as these "Twenty-somethings" are starting out in the workforce.

Additionally, many of these uninsured young adults have other priorities. The purchase of a new car or getting a better place to live is more important. Many of them are more concerned with climbing the corporate ladder or increasing their social status. The idea of health insurance is typically further down the priority list. However, if a serious illness or accident occurs, the cost of recovery is significant. These people will need to consider alternative options for health care that will not be cost prohibitive, especially when a pre-existing condition may prevent them from getting private insurance. And, rates are much cheaper for individuals under age thirty.

The Institute of Medicine attributes over 18,000 deaths per year to a lack of coverage. And 42% of the uninsured have no usual source of care—they miss out on preventive screenings and care for chronic conditions. The Kaiser Foundation notes that about 50% of the uninsured postpone health care because of cost. Because they do not receive early treatment and regular preventive care, the uninsured are highly likely to be hospitalized and die from preventable causes. Even men and women in their Twenties get sick or suffer injuries from unexpected events. Younger adults change jobs more frequently earlier in their careers leading to periods between jobs when they are uninsured; and they tend to be single with lower paying jobs. Also, ethnicity widens these disparities: 47% of black and 62% of Hispanic 19-23 year-old men who are not in school full-time are uninsured as noted by the Institute of Medicine.

The Institute also discovered that uninsured patients have worse clinical outcomes than insured patients for several chronic conditions including diabetes, cardiovascular disease, end-stage renal disease, HIV infection and mental illness. Uninsured women with breast cancer have a 30 to 50 percent higher risk of dying than women with private health insurance. The Commonwealth Fund has reported that 39% of uninsured young adults stated that they would wait as long as possible to receive health care, compared to 16% of insured young adults. About 40% of young adults receive no preventive care each year, and about half of this demographic population go without necessary medical care. About two thirds of those with medical bills report not being able to pay them. So the cost of being uninsured is still high, even as a young adult.

When no one pays the bill, we all suffer the consequences. Uninsured young adults who default on health care expenses push the recovery of cost to taxpayers, the health care system and providers. Severe financial strain on health care providers often leads to loss of important community resources and redirection of funds away from core public health programs.

The young adults in the 19 to 29 age bracket need to recognize that good health is not a given. Even when there has been a lack of medical problems, a smart plan would be to have some type of coverage for major health issues, especially for catastrophic events. Options in the market place exist for young adults to make sure they have their bases covered for health care needs. Don't go without if at all possible. It will be one of the best decisions made among those that address important financial and physical needs. Being a Young Gun is more about hitting the bullseye than missing the target.

Until next time. Let me know what you think.

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