For Uninsured Young Adults, Do-It-Yourself Health Care
They borrow leftover prescription drugs from friends, attempt to self-diagnose ailments online, stretch their diabetes and asthma medicines for as long as possible and set their own broken bones. When emergencies strike, they rarely can afford the bills that follow.
"The time has come for health care to be a right and not a privilege, or in my case, an onerous burden."Adam L., Albany, NY
“My first reaction was to start laughing — I just kept saying, ‘No way, no way,’ ” Alanna Boyd, a 28-year-old receptionist, recalled of the $17,398 — including $13 for the use of a television — that she was charged after spending 46 hours in October at Beth Israel Medical Center in Manhattan with diverticulitis, a digestive illness. “I could have gone to a major university for a year. Instead, I went to the hospital for two days.”
In the parlance of the health care industry, Ms. Boyd, whose case remains unresolved, is among the “young invincibles” — people in their 20s who shun insurance either because their age makes them feel invulnerable or because expensive policies are out of reach. Young adults are the nation’s largest group of uninsured — there were 13.2 million of them nationally in 2007, or 29 percent, according to the latest figures from the Commonwealth Fund, a nonprofit research group in New York.
Gov. David A. Paterson of New York has proposed allowing parents to claim these young adults as dependents for insurance purposes up to age 29, as more than two dozen other states have done in the past decade. Community Catalyst, a Boston-based health care consumer advocacy group, released a report this month urging states to ease eligibility requirements to allow adult children access to their parents’ coverage.
“There’s a big sense of urgency,” said Susan Sherry, the deputy director of Community Catalyst. She described uninsured young adults as especially vulnerable. “People are losing their jobs, and a lot of jobs don’t carry health insurance. They’re new to the work force, they’ve been covered under their parents or school plans, and then they drop off the cliff.”
If Governor Paterson’s proposal is approved, an estimated 80,000 of the 775,000 uninsured young adults across New York State would be covered under their parents’ insurance plans. That would leave hundreds of thousands to continue relying on a scattershot network of improvised and often haphazard health care remedies.
In dozens of interviews around the city, these so-called young invincibles described the challenge of living in a high-priced city on low-paying jobs, where staying healthy is one part scavenger hunt and one part balancing act, with high stakes and no safety net.
“For a lot of people, it’s a choice between being able to survive in New York and getting health insurance,” said Hogan Gorman, an actress who was hit by a car five years ago and chronicled her misadventures in “Hot Cripple,” a one-woman show that was a hit at last summer’s Fringe Festival. “There was no way that I could pay my rent, buy insurance and eat.”
Nicole Polec, a 28-year-old freelance photographer living in Williamsburg, Brooklyn, said she has attention deficit hyperactivity disorder and has a client who procures Ritalin on her behalf from a sympathetic doctor who has seen Ms. Polec’s diagnosis. Ms. Polec’s roommate, Fara D’Aguiar, 26, treated her last flu with castoff amoxicillin — “probably expired,” she said — given to her by a friend.
When Robert Voris last had health insurance, in 2007, he stockpiled insulin pumps, which are inserted under the skin to constantly monitor blood-sugar levels and administer the drug accordingly. He said the tubing for the pump costs $900 a month, so lately he has instead been injecting insulin with a syringe. But Mr. Voris, 27, a journalism student at the City University of New York who works at a restaurant in Park Slope, Brooklyn, is constantly worried about diabetes-induced seizures like the one that sent him to the hospital last summer. (Because it happened at work, his boss covered the ambulance and other bills.)
“That’s definitely the concern: what happens if I have to pay for this?” he said. “And the answer, I guess, is credit cards. Hopefully it won’t happen until I find a job that actually gives me insurance, which probably won’t happen anytime in the near future, given the way the economy works.”
Most family insurance policies cut off dependents when they turn 19 or finish college, and many young adults start out in New York cobbling together part-time or freelance work with no benefits. To qualify for Medicaid, a single adult can earn no more than $706 a month — less than what a full-time minimum-wage earner makes. Yet the average insurance premium for a single adult is $900 a month, according to a spokesman for the State Insurance Department.
“At this point, I can’t really justify it monetarily,” said Ian McElroy, a musician who moved to Bushwick, Brooklyn, from Omaha, last year. “It’s not like I think I’m invincible, I’m 29, the world can’t touch me. It’s the very opposite of that. I’ve got to make rent and eat.”
With insurance out of reach, Mr. McElroy has taken to playing doctor, using online resources like WebMD, which offers medical news, descriptions of various diseases and drugs, and discussion groups. As he spoke, Mr. McElroy was icing his feet, which, one day in January, had become cripplingly painful; he was unable to walk.
“I think I have plantar fasciitis,” he said. “I’ve been laid out for two weeks.”
(Even if the Paterson proposal passes, Mr. McElroy, like Mr. Voris and Ms. Polec and her roommate, would not qualify because their parents live out of state.)
Internet diagnoses, self-medicating and trading prescriptions, of course, come with potentially dangerous side effects. Dr. Barbie Gatton, who has worked in emergency rooms throughout the city since 2002, said she often sees young people who have taken the wrong antibiotics borrowed from friends.
“We see people with urinary tract infections taking meds better suited for ear infections or pneumonia — the problem is, they haven’t really treated their illness, and they’re breeding resistance,” she explained. “Or they take pain medicine that masks the symptoms. And this allows the underlying problem to get worse and worse.”
There are clinics throughout the city that provide the young and uninsured free or cheap snippets of medical help, like the Community Healthcare Network mobile unit, which was parked in the East Village one snowy night. Lindsay Bellinger, 26, who does administrative work through a temp agency and lives in Astoria, Queens, said she relied on the mobile unit for pap smears and tests for sexually transmitted diseases.
“This takes care of gynecological work,” Ms. Bellinger said. “And I get a visit to the dentist from my parents as a Christmas gift.”
Levon Aaron, who has asthma and works as a bouncer at a West Village bar, has not had insurance since he was 19. Mr. Aaron, now 23, said that his asthma attacks had been less frequent since he began playing handball and working out, but they had not gone away. He tries to use his inhalers sparingly, but four times in the past year he has found himself out of medicine during a severe attack and landed in the emergency room.
In the hospital, he gets a prescription for a new inhaler, which costs about $30 to fill. But his outstanding bills total about $3,000, he said, an amount he cannot fathom paying.
Mr. Aaron was one of several young adults who said living without insurance meant trying to take better care of themselves.
“I’ve stopped eating fast food,” said Santiago Betancour, who is 19 and lives in Rosedale, Queens. “I’m eating rice, vegetables and fruits. And when I get sick, I exercise to sweat it off.”
Of course, there are those who do feel invincible, like Eric Williams, who is 24, unemployed and currently in the middle of a six-week snowboarding adventure in Wyoming, Montana, Colorado, Utah, British Columbia and California. Mr. Williams said by cellphone near Bozeman, Mont., that he looked into buying health insurance before he left, but abandoned the idea after being unable to find anything for less than $400 a month. Instead, he is just trying to be careful, though not always with success.
“I’ve hit a couple of trees,” Mr. Williams said. “But I’m trying not to.”