Crib Sheets:

Young, Underinsured and Overcharged

Final health care reform legislation may include a plan specifically for young people, but that plan isn’t all it’s cracked up to be.

By Natasha Bowens
October 26, 2009

(iStockphoto)

At this point in the game, we have all heard the countless arguments flying around during the health care reform debate: the back and forth over the public option; the seniors expressing their concerns with Medicare; advocates for low-income communities fighting for bold affordability measures. We’ve even been hearing more from our generation—the Millennial generation, ages 18 to 34—about how we will be impacted by health care reform. We do, after all make up the largest group of uninsured.  However, it is clear that this generation still carries the stigma of having an attitude of being “invincible” when it comes to our health, but the truth behind that stigma reveals an argument in the reform debate that we have yet to hear.

Chairman Max Baucus (D-MT) and colleagues on the Senate Finance Committee added a few lines to the health reform bill they were working on that described a “Young Invincibles” insurance plan. (Yes, that was the actual name of the plan written into legislation.*) And just like that—Presto!—problem solved. Young adults up to age 25 would now be able to purchase health insurance from a private insurer at a low monthly cost. The committee created a cheap plan that would bring in tons of money for insurance companies.

This plan is, of course, too good to be true. Let’s delve a little deeper into this brilliant “Young Invincibles” plan, shall we?

What the Senate Finance Committee has essentially created to cover young adults is called a “catastrophic plan.” These types of plans have low monthly costs but very high deductibles, or an out-of-pocket expense that the customer must pay up to a certain limit. Once that customer reaches the limit, the insurance company will pay the rest. In the case of the Senate Finance Committee’s “Young Invincibles” plan [pdf], the insurance companies will only cover catastrophic care after you pay up to a $5,800 deductible. The point is that these plans can be cheap for the consumer when something goes really wrong. But the “catastrophic” plans have low premiums and high deductibles, so Mr. Insurance will only cover serious accidents and other extreme medical instances after you pay thousands of dollars to cover your deductible.

Catastrophic plans, like the "Young Invincibles" one offered up by the Finance Committee, provide limited preventive care such as colon cancer screenings and not much else; therefore excluding the more common care we need like prescription drugs or regular check-ups and preventive screenings. Services such as gynecological visits, prescription drugs, emergency room visits and primary care visits will have to be paid by you, the “invincible.” This plan isn’t sounding so brilliant any more—it is essentially leaving young people underinsured and overcharged.

Some of us do take risks or decide to go without insurance, paying out-of-pocket when we need treatment once a year. But this doesn't represent all 13 million of the Millennial generation without health insurance. In fact, one of the biggest reasons young adults are uninsured, contrary to the popular thought that it’s because we don’t think we need coverage, is because we simply cannot afford it. According to a report [pdf] by the CommonWealth Fund, two-thirds of young adults don’t have health insurance because of high costs.

Even those who are insured, especially by plans with high deductibles, are struggling with costs. According to The CommonWealth Fund, 55 percent of adults with deductibles above $1,000 spent over $1000 per year on out-of-pocket costs for health care, not counting premiums, and 13 percent spent more than $5000 a year. Nearly half of adults in high deductible plans with incomes of less than $50,000 reported delaying or avoiding care, almost twice the rate of similar people in more comprehensive plans.  This will most definitely affect young adults because 80 percent of us make under $40,000 [pdf]. No one should have to avoid or delay necessary care because of costs, especially when such forced behavior could have tragic results.

To make things worse, the “Young Invincibles” plan is also going to be offered to Americans of any age whose premium costs exceed 8 percent of their household income. Sen. Baucus and friends may have thought they could kill two birds with one stone and insure about 8 million “young invincibles” as well as about 17 million low-income Americans who would not be able to afford the monthly costs of health insurance even after federal subsidies. But it is clear that this plan will not necessarily be more affordable for them, especially with the above statistics on the out-of-pocket costs that are common with catastrophic plans.  

There is good reason for the Millenial generation to want more than just catastrophic coverage, since 15 percent of young adults suffer from diseases such as diabetes, asthma or cancer; 24 percent are obese; 25 percent of all HIV diagnoses were made among young adults ages 20 to 29. Young adults also have one of the highest rates of injury-related emergency department visits of all age groups. And let’s not forget medical care for pregnancies—there were 2.6 million women ages 18 to 29 that gave birth [pdf] in 2007.

This all means that young adults need comprehensive health insurance. It is not fair or smart to leave us underinsured, especially when the high costs we would pay through deductibles would not even be worth the barely-there coverage. Granted, Senator Baucus may argue that his plan is an effort of ensuring that young and low-income Americans have something to turn to for health insurance, but the best way to do this is to include a public option in the final reform bill.

A public option would provide a low-cost, comprehensive health insurance plan for young adults and low-income Americans—or, for that matter, anyone who wanted—to opt into. Congress is working now to combine all the reform bills on the table into one final bill, and many progressive members and organizations (including Campus Progress and the Y.I. Want Change Coalition) are fighting to ensure a public option is included and is easily accessible. However, if a “Young Invincibles” plan does make it to the final legislation as well, it should be modeled after the Massachusetts "young adult plan" which requires “reasonably comprehensive” coverage with a maximum $2000 deductible, primary care coverage, the option of prescription drug coverage, and premiums still offered at a low cost. The plan should also expand covered services and define preventive benefits to include common preventive and primary care treatments including regular check-ups, regular visits to the doctor, cancer and heart disease screenings, and gynecological visits. Finally, the plan should cover treatment of chronic conditions.

If this generation is to lead the way into the future, let us lead the way into a future where our health and economic stability are not cheated. When health care reform is expected to pass—supposedly by Thanksgiving—let’s hope we will be looking at a future of being young, comprehensively insured, and charged fairly for our health insurance.

* The name of the plan in the Senate Finance legislation has now been changed to "Catastrophic Plan for Young Individuals".

For more information on health care reform and its impact on young adults, please visit campusprogress.org/healthcare, or our health care coalition site yiwantchange.org.

Natasha Bowens is an advocacy associate for Campus Progress.

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Comments

1. The hierarchy of agencies within the government are paid millions a year in bonuses. For what? Stop that waste and use the money for health care programs.

   — Martha Stefas - Oct 26, 07:58 PM - #
   
   

2. The hierarchy of agencies within the government are paid millions a year in bonuses. For what? Stop that waste and use the money for health care programs.

   — Martha Stefas - Oct 26, 07:58 PM - #