One Strike and You’re Out

You can’t play softball if you don’t have health insurance.

By Ezra Klein

Softball is a D.C. institution. Congressional staffers, organized by caucus or member, play it with such vehemence that a league recently broke apart, with angry Republican staffers accusing Democrats of using a playoff system that pits the strong against the strong, rather than the strong against the weak. Spitting that this was “softball welfare,” 80 Republican teams broke off into their own, more suitably Darwinian (but not in the “world is more than 6,000 years old” sense) league.

The D.C.-based nonprofits play softball also. That’s how my roommate happened to be in the dugout yesterday, cheering as his colleague went up to bat. The colleague connected and turned to sprint towards first, but his cleat caught the dirt, and his leg, pulled in two opposite directions, ripped apart at the knee. A couple hours later, my roomie confided that that would be the last time he’d pick up the bat. He lacks health insurance, and such an event would bury him beneath medical debt.

You know the stat — 46 million Americans uninsured. What you may only have guessed is how many of them are young. According to a new Commonwealth Fund study, 13.7 million young adults (ages 19-29) lack coverage. That’s an increase of 2.5 million since 2000. Even though we make up just 17 percent of the under-65 population, we’re a full 30 percent of the non-elderly uninsured. And we’re the fastest growing group, too. Hurray for us.

Of those who don’t attend college, nearly half will be uninsured during the year after high school. Among college graduates, two out of five will lose their insurance after leaving the university’s comforting embrace. It’s a problem that affects rich, upwardly mobile kids and poorer, less affluent ones alike, and it happens because we stand at the nexus of our parents’ coverage and deteriorating benefits for low-income and young workers.

Growing up, most of us have health insurance through our parents. But if you take a pass at college, you’re generally dropped as soon as you turn 19 — even if you remain a dependent. Or maybe you come from a low-income family and get your health care through Medicaid or the SCHIP. Unless you qualify for Medicaid as an adult (and childless young folks rarely do), you’re out of luck.

Of course, if you’re graduating high school, you’re probably entering the job market. What about employer-based care? Well, jobs for high school graduates are generally low-wage and transient, exactly the sort of workplaces least likely to offer health coverage. Sorry.

Meanwhile, say you went off to college. Good choice! You may have been kept on your parents’ plan, or gotten on the school’s insurance. But then you graduate. Tough day: You’re leaving the womb, etc. Now you’re working an internship or entry-level position. How likely is health care? Not very. My roomie is a paid research associate at a top think tank, but they don’t offer their RAs coverage. No wonder they favor universal health care — then they wouldn’t have to feel so guilty.

This hits at all levels. The low-income are worse off, to be sure, but studies found that two-thirds of young adults between 19-23 went without care for some period during 1996-2000. That’s because the number of people without coverage is just a snapshot at any given time. If you looked at the number of people who were without health coverage at point or another over a period of time, it affects even more people.

The upside, as you sometimes hear, is that we’re young, we don’t need coverage. After all, who needs Blue Cross when you’re invincible, right? Not quite. It’s true that young people are at lower risk for, say, cardiovascular disease. But 14 percent of us are obese. 3.5 million get pregnant every year (and you need pre-natal care). One-third of all HIV diagnoses are made among young adults, and we’re by far the most likely to limp, stumble, or get carried into an emergency room with some sort of physical injury.

The outcome of all this is fairly obvious: medical debt. If you’re uninsured and you get in an accident, or get sick, you’ll end up at the doctor and be stuck with the bill. Worse, it’ll be a bigger bill than the same injury or ailment would net for someone with coverage. Insurance companies bargain down treatment costs with hospitals, which then recoup their investment by charging those without insurance more. Slick, huh? That’s why more than one-third of young adults reported problems with medical bills, ranging from garnished wages to trouble making payments to unpleasant confrontations with debt collectors.

So being uninsured is bad, and it’s bad when you least expect it. What can you do? Well, you can buy insurance on the private market. eHealthInsurance.com will give you quotes and let you compare various plans, and while I’m not normally a fan of Health Savings Accounts and the like, if that’s all you can afford, go for it. What’s important, particularly at this age, is that you’re insured against a catastrophe. And when you’re young, you can get catastrophic plans for pretty cheap.

You could also write some letters and otherwise agitate politically for the government to expand coverage to young adults. We’re inexpensive to cover but rarely in a position to negotiate effective or affordable coverage for ourselves. Allowing us to buy into SCHIP, Medicaid, or even Medicare would work just fine. But till then, by hook or by crook, get yourself a plan. And then go kick ass at softball.

Ezra Klein is a writing fellow at The American Prospect. He also writes a blog at www.ezraklein.com.

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