The young and uninsured

When you're as excited as Jon Villasurda is to be a test subject for dental board exams, something is very wrong. Barely batting an eyelash at possibly becoming a failed exam at the hands of University of Michigan dental students, Villasurda was ecstatic the other day about the prospect of having his teeth filled for free. Even if it meant being a guinea pig.

Villasurda, 23, spends most of his waking hours studying. While many of his friends work the 9-to-5 grind, Villasurda is a master's candidate in the Health Management and Policy program within the University of Michigan's School of Public Health. He's on a personal crusade against a health care system that has left his family in peril. That's what fuels his drive to succeed. His goal is to help shape health care reform in the United States and benefit families like his who are uninsured or underinsured.

Villasurda was dropped from Medicaid when he turned 20. And full health insurance won't be an option until he lands a job with benefits. To say that he's strapped for cash would be an understatement. With only one semester of graduate school under his belt, his loans are already at $35,000 and climbing.

Villasurda looked into health insurance offered by the university but deemed it too expensive.

"Some people might argue that $2,000 a year for insurance through the University isn't that much," says Villasurda. "I argue that $2,000 is $2,000, especially coming from a family where that is a significant portion of your total income."

Villasurda is hardly alone in his predicament. Nearly 47 million Americans lack health insurance. Another 16 million qualify as underinsured due to high "out-of-pocket costs relative to their income," according to the Commonwealth Fund, a nonprofit group that promotes improved health care for Americans. Moreover, young adults between ages 19 and 29 make up the largest portion of uninsured in the United States, totaling about 13.2 million in 2007, according to recent data from the Fund. That's right — young adults make up more than one-fourth of uninsured Americans.

"Many times after finishing high school or college, young adults get kicked off their parents' plan and, oftentimes, there is a gap between that health care coverage and finding a job with health benefits," says Tamara Draut, vice president of policy and programs at Demos, a nonpartisan public policy research and advocacy organization in New York City. "One of the main reasons for the high rate of uninsurance among young people is that the quality of jobs has declined for young workers."

From 1979 to 2004, the percentage of young workers in jobs without health care coverage or pension plans has grown from 34.7 to 40.8 percent, according to Demo's Economic State of Young America Report from 2008 (citing data from the Center for Economic and Policy Research). And as our nation staggers into the worst recession in decades, workers' current reality gets worse by the day.

"Even with a bachelor's degree, it can be hard to secure a full-time job," says Draut. "Companies are increasingly hiring on a project basis, leaving many young people in a state of perma-lance. They work full-time, but don't have access to employee benefits like health care or retirement plans."

And don't think that young adults haven't taken notice. Last September, with the presidential election approaching, Rock the Vote polled young voters on the critical issues. On a scale from 1 to 10 (with 10 being the most important), 45 percent of those polled rated health care a "10."

Do-it-yourself health care

Two years ago, Nicole Marie Polec moved from her home in Romeo to New York City. She was bent on photographing everything from up-and-coming indie bands to cute kids scurrying around Central Park. Polec now lives her dream, but the price she pays landed her in a front-page New York Times article, "For Uninsured Young Adults, Do-It-Yourself Health Care."

Polec, a former Metro Times photographer, is one of many uninsured young adults who use creative and sometimes dangerous methods to evade a doctor's bill. They procure prescriptions from doctors, swap expired pills and self-diagnose ailments through sites like WebMD. At times, attempts to avoid care land them in a gurney at the emergency room. For now, Polec gets medical advice and her attention deficit hyperactivity disorder (ADHD) prescriptions from a sympathetic doctor she knows through a client.

A few days after a manicure, Polec's middle finger turned green and swelled. She soaked it in salt water while frantically searching WedMD. A blister formed under her nail, causing her more pain and anxiety. Her thoughts swarmed with fears of gangrene and amputation. But her connection to a real live doctor eventually saved the day. After a brief phone call, she followed the doctor's orders — simply soak her finger in salt water and pop the blister. Polec's finger healed, with not a penny spent.

Going on three and a half years without health insurance, Polec refuses to give up her art for health coverage.

"When you have to choose between a TV dinner and paying a health insurance bill, wouldn't you rather eat? I'd rather put food in my stomach," says Polec. "And, if I pay health insurance, then I can't afford my prescription for my ADHD. It's a catch-22."

Unlike Polec, some young people skip health insurance "because they think they won't need it. They are generally healthy," says Marianne Udow-Phillips, director of the Center for Healthcare Research and Transformation. But in large part, the problem is cost.

"Coverage that is affordable for youth tends to be the type of coverage they don't think they will need, e.g., catastrophic coverage. It generally doesn't cover the things that they think they will use (office visits, birth control and the like). So, many of them choose to save that money and take the risk," she says.

Gov. David A. Paterson of New York has pushed for at least one policy that promises to help people like Polec. He wants health insurance companies in the state to allow young adults to be covered under their parents' policies until age 29.

More than two dozen states have already moved in this direction, mandating that children be allowed to stay on their parents' policies to a set age. Michigan lags behind. Dependent coverage varies from policy to policy, resting on the agreement between employer or individual and provider.

Blue Cross Blue Shield of Michigan is the largest health insurance provider in the state. Under BCBSM employer-based plans with dependent care, dependents can be covered until they turn 25. Age limits and requirements such as student status and income level of the dependent are based on the contract between the employer and BCBSM. In individual plans, coverage is offered until during the dependent's 25th year.

Young adults sing the Big 3 blues

In the glory days of the Big Three, Michigan was known for stellar benefits compared to most other states. That's no longer the case. As of 2007, 21.5 percent of young adults 18 to 24 and 24.7 percent of individuals 25 to 34 are uninsured, the Ann Arbor-based Center for Healthcare Research and Transformation (CHRT) disclosed in its 2009 Cover Michigan report. Michigan's numbers are still less than the national average, which is 28.1 percent for 18- to 24-year-olds and 25.7 for 25- to 34-year olds.

But the ranks of the uninsured in Michigan are steadily rising. In the 1999-2001 period, an average of 20.7 percent of Michigan residents ages 20-29 were uninsured; in the 2004-2006 period, the figure hit 30.7 percent, according to the Michigan Department of Community Health.

"I think that, for young people, the economy in Michigan is particularly brutal," says Draut. "It's an economy in transition where the backbone of the old manufacturing-based economy has dwindled, making it very difficult for people without college degrees to find a decent-paying job that comes with health insurance benefits and retirement benefits."

Udow-Phillips says rising health care costs are also to blame.

"The cost of health care has increased significantly," says Udow-Phillips. "As stated in Cover Michigan — our recent report on health care coverage — from 2000 to 2006 the cost of family premiums increased by 68 percent both in Michigan and nationally, but in a very difficult economy like Michigan's it is harder and harder for businesses to absorb the cost. More businesses are dropping coverage due to these rising costs, and the particular challenges in Michigan's economy exacerbate that situation."

Bill Jones, who asked that his real surname not be used, is the first in his family to graduate from college. As a full-time student, Jones was eligible for coverage as part of his mother's benefits as a Chrysler employee represented by the United Auto Workers (UAW).

As Chrysler and UAW renegotiated contract after contract, Jones watched his family's coverage dwindle throughout his childhood and into college. Eventually, co-pays became so high that even emergency measures were put on hold.

"If there was a contract being negotiated, you knew you were going to lose some portion of coverage or that co-pays were going to go up," says Jones.

Flash forward a couple years to an altercation at a college party. Suffering a head gash from a 10-pound weight, a bloodied Jones pleaded with police not to call an ambulance.

"I said, 'No. I can't go in an ambulance because my health coverage won't pay for it.' So they drove me to the hospital," recalls Jones.

Along with the head wound, Jones suffered whiplash, which required ongoing treatment. Physical therapy was free through the University Health Services while Jones was enrolled in courses, but the cost of services such as an MRI and electromyography totaled more than $600. At the end of the semester, physical therapy was bumped up to $90 a month. With these high co-pays accumulating, Jones stopped treatment.

Without physical therapy, Jones' whiplash symptoms worsened. Pains shot through his neck, and he lost feeling in his left hand. Using online medical sites such as WebMD, Jones tired to diagnose himself and felt anxiety over the possible ailments his symptoms pointed to – varying from multiple sclerosis to carpal tunnel syndrome.

Luckily, Jones' pains eventually went away.

Coverage that doesn't cover

Even if young adults do land a job with benefits, they're not always adequate. Mary Hennessey transferred from her mother's health insurance to coverage under her AmeriCorps position at a local Detroit nonprofit after graduating from the University of Michigan. Unlike her mother's health insurance, which covered dermatology visits, her new plan didn't.

This was a bit of a problem for Hennessey, who has psoriasis — a chronic and incurable skin disease. She can manage it provided she has the right medical support and access to up-to-date prescriptions and treatments. Since she was a child, Hennessey regularly used these, improving her condition and confidence. Some of these, including access to a special UV light box (similar to a tanning booth) that gives skin a special dose of light, can cost a couple hundred dollars per session.

Hennessey's AmeriCorps position ended in December 2008, and she hopes to get major medical coverage until she lands a job with benefits. Even then, she fears her future HMO will turn her away due to her pre-existing condition. For now, she tries to stay healthy and make due.

"I have just been trying to be very careful and make my psoriasis prescription last longer," says Hennessey. "I'm also trying to use more alternative therapies like herbal teas and vitamin supplements — not so much treating diseases but trying to stay healthy."

Like Hennessey, others who are uninsured and underinsured often take precautions in nutrition and daily activity to stay healthy. Once an avid soda drinker, Villasurda now rarely touches the stuff. Nutrition, dental hygiene and keeping a low stress level are his keys to staying healthy.

Jones is also more health conscious since becoming uninsured. He exercises regularly, but he sticks to an elliptical machine at the gym. "Risky" pastimes like biking or running are out of the question.

"I don't run anymore because running on a daily basis can lead to repetitive motion injuries," says Jones. "I don't ride bikes now because of the risk of an accident."

The policy puzzle

Udow-Phillips explains that high numbers of uninsured people affect businesses on a national and global level. Sick and disgruntled employees reduce business productivity. And when more people seek care in emergency situations, costs are higher. Hospitals and other providers must absorb the cost of uncompensated care for the uninsured or underinsured, contributing to the growth in premiums and co-pays.

On a global scale, many developed countries have some form of universal health coverage provided or subsidized by their governments. "Competing with those corporations means a cost disadvantage to business in the U.S.," says Udow-Phillips.

Villasurda isn't waiting around for policies to change — he wants to help make them after he completes his master's in health services administration. His drive to help people like his own family fuels his desire to succeed.

Growing up, Villasurda saw the financial and emotional strain brought on by a lack of health insurance. While his grandmother financed her dental work on a credit card, his father once hesitated visiting the ER for a pain in his abdomen. Ultimately doctors diagnosed a ruptured appendix. A wrong decision could have been fatal.

After Villasurda became uninsured, his dental woes prompted him to seek out untraditional arrangements for care. His father had received care from a dentist who was open to bartering services as opposed to payment. When Villasurda had a tooth filled, Villasurda's father would clean the dentist's carpets for free. After the dentist passed away in 2008, getting fillings from dental students is the only affordable option he's found.

"I hope that I can contribute to changing our health care system by making services easier to access, less stressful and more affordable for people like myself and my family," says Villasurda. "A horrible feeling is when you see your own grandmother that raised you become sick, and then start to persistently worry about how she is going to finance her treatment."

A proponent of universal health care, Villasurda doesn't think it's the only health-related piece of the puzzle that needs to be solved.

"People still have to make changes to their lifestyle," says Villasurda. "That's why public health is extremely valuable, to help people with their behaviors and to educate them on how to be healthy. People of all socioeconomic backgrounds need these public health interventions so that they may communicate to their loved ones the importance of prevention."

Some 'hope' for the future

Villasurda is among those who hope that President Obama's plan in the recent budget marks the beginning of progress toward universal health coverage.

President Obama proposes establishing a reserve fund of $630 billion over the next 10 years to "finance fundamental reform of our health care system that will bring down costs and expand coverage." Beyond that, the proposal calls for future efforts leading to health care for all Americans.

Even in the past weeks, health care reform has gained momentum. The White House health care summit brought together medical professionals, lawmakers and business groups to discuss health care reform. There are also plans to hold regional forums in key states, including Michigan.

Demos and Draut hail this plan as a new step toward the promise of universal health care.

"It could be a huge benefit to young people who have been feeling the pain of not having access to affordable health insurance," says Draut.

Ultimately, Draut projects that we will see some form of universal health care in the next four years.

Some advocates for universal health care remain skeptical. Jones voted for President Obama, but he has his doubts.

"Hillary Clinton tried to do the same thing in the '90s," Jones says. "And, even if the government does provide a form of subsidized health coverage, I still don't expect universal health coverage to be as good as private health coverage offered through an employer."

Others remain hopeful, citing universal health coverage as fundamentally linked to American moral values. Villasurda, too, hopes that his fellow citizens will endorse health care for all and help create a more equal and prosperous society.

"We are America — and we have never settled for second-best. But unfortunately that's what our health care system is."