The New Health Dialogue

Nineteenth birthdays are usually not particularly scary occasions. But for Brittany Hunsaker, turning 19 made her one day too old to qualify for the Kentucky Children’s Health Insurance Program (KCHIP), the state-sponsored health insurance program for low-income children ineligible for Medicaid.

"I feel like I am being penalized for getting an education while others are rewarded for their reproductive capabilities," Brittany said in a report she did about herself and similarly situated friends on NPR’s Youth Radio.

Uninsurance always makes the perfect birthday present.

Brittany got sick right after her 19^th birthday. She felt pain in her teeth which spread to her head and neck; the unbearable headaches made attending classes at the University of Kentucky essentially impossible.

But when a doctor’s visit consumes more than a week’s paycheck, Google becomes a diagnostician, and an oral surgery bill makes course textbooks simply out of reach -- there's a big problem.

Brittney acknowledges that she does have health care options. But not good (or affordable) ones for a college student of very limited means. “You can get health care if you’re in a dire situation -- say, if you’re pregnant or recovering from drug addiction,” explains Brittany, who is trying to break her family's cycle of poverty by becoming the first to go to college. “I know a few girls who got pregnant just to afford a doctor’s visit, or had another baby just to keep their health insurance (under Medicaid).”

College students should be worrying about term papers, exams, internships, jobs. But that's not the case for Brittany and many of her friends. “We’re constantly being told we are the future of the country, but we’re starting out a step behind,” Brittany laments. How can we concentrate on our studies and future when we’re worried about how to pay for ER visits, eyeglass prescriptions, medications or dental work? “A sick workforce,” she continues, “only intensifies an already sick economy.”

Brittany also fears that it won't get much better when she enters the work force. Getting a job in this economy is hard enough. Getting a job that provides health insurance is even harder.

“We don’t make the connection between employment data and health care often enough … more Americans will have problems paying for health care and health insurance and delay or forego care while the economy rebounds,” explains Drew Altman, President and CEO of the Kaiser Family Foundation. And, as David Leonhardt wrote earlier this week in the New York Times, our health care problem is contributing not only to our budget deficit -- but to our innovation deficit as well. Leonhardt explains:

Even before the financial crisis, the decade that will end later this month was on pace to have the slowest economic growth of any since before World War II … Given the consequences of the innovation deficit -- slower growth, fewer jobs, lower living standards -- you would want to look for every possible solution, wouldn’t you? … And you would want to make people feel confident that they could take risks -- start a new company or join a young one -- without worrying about whether they would still receive adequate medical care.

That's Brittany he's talking about. And if I hadn't been lucky enough -- that could have been me too.

We’ve written about the economic case for health reform countless times before. But it’s critical to point out, once again, how the high costs of health care can cripple the elasticity of our youth and crush our country’s innovative spirit -- and how the high cost of health care forces many of the 20-somethings to forego health care or pick a job that may not be the best for both personal and societal growth. In 2006, the number of uninsured Americans between the ages of 18 and 24 reached 13.7 million.

But health reform will provide college students and young graduates with more affordable coverage options. For example:

• Dependent Coverage: Young adults will have the option to stay on their parents' insurance plans until the age of 26 or 27 -- regardless of their student status. That option goes into effect in 2010. It doesn't necessarily help someone in Brittany's situation, but it will help other young people and their families immediately.
• "Young Invincibles": The health reform legislation features a young invincible plan that covers catastrophic medical costs -- and evidence-based preventive services are not subject to the deductible. It's a way of helping young people fulfill an individual mandate, without going broke or risking going broke if they get sick.
• Health Insurance Exchanges: Reform legislation will create health insurance exchanges through which individuals and small businesses will be able to purchase insurance coverage; eligible individuals under 400 percent of the federal poverty level will be eligible for government subsidies.

So health reform may not help Brittany pay for her textbooks this year. But change is coming.