The stories of four un- and underinsured Ithaca College students
The U.S. healthcare system is unlike any other in the world. It’s a patchwork that has overlapping public, private and out-of-pocket models. Yet, in the midst of the Medicare, Medicaid and insurance companies, there remains a group who’ve consistently been missed — young adults. It is the 20-somethings that have always had the highest uninsured rate of any age group, around 30 percent.
Despite major improvements for young adults by the recent Affordable Care Act, economic downturn and a bleak job market significantly weaken these improvements. Employee-sponsored care has been the main provider for most young adults, but as fewer jobs offer healthcare and more students take part-time jobs, that option continues to disappear.
With a system that has elements of all healthcare models, U.S. policymakers have chosen to implement small changes that are only minor chips away at the large U.S. healthcare structure, rather than one massive reform. While these steps have done much to increase coverage, they’ve done just as much to drive up the cost. As the difficulty of obtaining insurance rises, so do health care costs. For young adults, this has become a harsh aspect of their economic reality: credit card debt is 79 percent higher for young adults with medical debt than those without — a greater difference than for any other age group.
In this post-‘Great Recession’ era, young adults continue to face obstacles in their quest for medical care. Here are the stories of four Ithaca College students’ battles:
Standing in the teen center of a local walk-in clinic, Jillian Doyle pleaded for birth control.
“I said I was really Catholic and my parents don’t know about me having sex and if they find out, they’ll kick me out of the house.”
None of that was true, of course. “I lied and told them this story so I didn’t have to pay for it. I did get checked out and I did get some form of health care. Just kind of using the system, I guess.”
Doyle was on New Hampshire’s Healthy Kids healthcare program until she was dropped from the plan when she turned 19. She then started to search for medical care wherever she could.
Doyle said her mom warned her before entering college that she’d eventually be kicked off her plan, but she admits her own naiveté — a common theme when health care education is not the norm.
“I just went into college not knowing anything about what was going on and thinking I was just like anyone else and everything would be taken care of.”
Her freshman year she attended the University of Southern Maine, where she joined the cross-country team for the first time in her life. She shined as the number 4 runner on the team, until she got kicked off due to NCAA regulations that say athletes can’t compete without some form of health insurance. It was her first slap in the face.
“[Cross-country] was how I built my identity at that university. I tried to talk to my coach about it … to the people who represented the NCAA at the school — they couldn’t do anything for me.”
She looked into the college health insurance, but it was far too expensive. USM’s health insurance has a premium of a whopping $1,648 a semester. So, she looked into private plans, but everything seemed like a gimmick or scam.
She transferred to Colby Sawyer College where she only spent one semester the only way she could afford — abroad in Florence, Italy, where housing was cheaper and the program included healthcare.
Doyle then took a semester off, taking online community college courses and working as a ski instructor, where she held back from doing much of the hikes and skiing she loved for fear of paying for any injury care.
After working for a period of time, she found Ithaca College and had saved up enough to afford the school’s health care, and is now currently on her father’s employee-sponsored insurance.
Looking back, Doyle said it’s hard to explain her experiences to people.
“They are not going to see beyond their own experience. I think there needs to be more education and people need to pay attention more and…learn that this is an issue.”
This summer, Connie Honeycutt wanted to go to the doctor because of an infection, but was sent to the emergency room instead because it was a holiday. When emergency room charges came in, she wondered why her father’s insurance, his new “premium plan,” didn’t cover them. She eventually found out that the plan left her responsible for a $2,000 out-of-pocket deductible and, even then, only covered her at a percentage.
“There is so much medical terminology that is just not explained and they just say ‘[We] can do this, therefore we are, and you signed a paper.’”
Honeycutt is frustrated that young people simply aren’t taught even the basics of the health care system, leaving them vulnerable to be tricked and charged. She watched her older sister, who was dropped from her mother’s coverage at the age of 18, struggle with medical care.
“There was a chunk of time in college, and then after she graduated, where she didn’t have insurance and she would self-medicate. She would just do things she probably should not have done.”
Honeycutt said she’s lost all faith in her system and in the plan that leaves her underinsured.
“I don’t trust my coverage at all. I’m just dreading knowing that I’m going to… think ‘OK, they’ve covered 80 percent’ and I find out that they covered nothing or 10 percent … You realize that it’s a business and it’s just making money just like any other business … and if you’re not educated and you don’t know how to work with the system, the system can really fuck you over.”
Although born in Queens, N.Y., Pamela Millan lived in Colombia until seventh grade. She said she remembers paying only a few dollars to get health care swiftly and easily. After moving back to the U.S., Millan was under state health insurance because her mother’s employee-offered insurance is more than they can afford.
In her freshman year of college, she found out she was kicked off her plan because she reached an age the government deemed “too old to be on Medicaid,” while simultaneously finding out she has rheumatoid arthritis — a chronic inflammation of joints that is very rare in young people.
“I started paying my bills out-of-pocket. And just to see my rheumatologist, it’s $700.”
She’s since been in a battle with Medicaid to keep her covered. Beyond her condition, earlier this year she had an anxiety attack that cost her a $1,000 hospital visit.
Despite her chronic illness, Millan said she keeps herself from getting the attention and medication she needs because of costs.
“I’ve seen my rheumatologist twice since I got diagnosed three years ago. I just don’t want to go. My mom doesn’t have the means. I don’t have the means.”
The average recommendation to see a rheumatologist is every three months.
“On days where I have flair-up, I’d just start taking a lot of Advil,” Millan said. “It has been getting worse, but I just can’t afford it, and I know that I will have to figure out how to do something about it soon.”
Over the summer, Colleen Cunha found out she had to get her wisdom teeth out, just when both her parents were switching jobs, making dental insurance unavailable.
“I go through weeks … where I can’t eat anything. My teeth … have shifted. I’m very aware of my teeth now because I know I should have gotten them out 6 months ago.”
After recently being put under her stepmother’s insurance, surgery during winter break was finally possible. Her concerns, however, aren’t over.
“In the end, it might come down to…taking out my teeth [or] having to fix them because they should have been out 4 months ago and it’ll cost more money.”
Cuhna also has a type of GERD’s disease — a digestive illness that’s rare in young people. Along with limiting her diet, Cunha has to take medicine every morning to help lower the acidity of her stomach. When she first came to Ithaca, she had issues with interstate prescriptions. She couldn’t pick up prescriptions in New York that were filed by her doctor in Massachusetts. She went to the college health center, where they ran tests and sent her to labs, but in the end, they told her nothing was wrong and refused to prescribe her anything. She is still filing insurance claims to cover the costs of those tests. As of now, she has her pills mailed to her.
On top of paying for her prescription medicine, she has to buy over-the-counter drugs to help her daily. Cunha estimates she spends $100 a month on medication — as much as she spends on groceries.
Like most young adults, she said when she finally learned about the health care system, it was far too late.
“It wasn’t until something like this happened to me that I sat down with my parents [and] it became a big deal for me to know how to get what I need.”
Closing the Gap
Young adults received some of the largest benefits among all age groups from the Affordable Care Act. The revision that allows an individual to stay on their parent’s plan until 26 insures a million more young adults alone. While these reforms seem promising, there is still a huge void, especially after the recent economic collapse. The number of uninsured young adults ages 18 to 24 continues to drop quickly — by a total of one million in the last quarter of 2010 and first half of 2011.
There is a great struggle to get health care in the age group that both public and private providers continue to ignore — the 20-somethings. Thus, these small changes to the U.S. healthcare system are only bandages on a large, gaping wound, where we so often find stories like these.
Merdina Ljekperic is a junior journalism and politics major who hopes for universal health care. Email her at mljekpe1[at]ithaca[dot]edu.