Mind the Gap

An article by Michelle Andrews in the New York Times (May 31) reported that many employers are unwilling to extend health coverage up to age 26 for the adult children of their employee’s until January 2011, when the federal law requires it. Insurers, eager to sell the add-on, had led customers to think it would be available as early as September. But few employers are willing to take on an increase in the steep cost of employee benefits. Neither the insurers’ nor the employers’ position is surprising.

Yet as I read the story of what one family is planning to do—spend more than $500 a month for the rest of this calendar year—just to purchase health insurance for their young adult son, I recalled my own blithe years without health insurance.
 
As a young college graduate living on my own, I worked for two years at a local bank, which paid for my health insurance. The employee benefits package also contained a life insurance policy—my first. (Naming a beneficiary had seemed like a rite of passage, a step deeper into adulthood, after getting a Social Security card, going out of state to university as a teenager and renting my first apartment.)

But I soon left that bank job behind to travel in Europe, where for more than a year I took various temporary jobs. And after returning to the U.S., I eventually made my home at Koinonia Farm in Americus, Georgia, where I lived for nearly five years, working in a Christian community for subsistence pay. The lack of coverage extended into the early part of my graduate education as well. Working part-time and studying part-time meant that I fell through the cracks, covered neither as an employee nor as a student. In all this time—nearly a decade—I bought no insurance of any kind, nor did I have much money to spend had I wanted insurance. That changed after I became a full-time graduate student and took campus jobs at Notre Dame, then Harvard. But there were summers without coverage and a gap between graduation and when the benefits of my New York job kicked in again.

Who cared? I was young and healthy.

Not once during those years did I consider buying health insurance. Had I done so, I might have told myself that statistics are on the side of the young; that risk is minimal. As it was, I lucked out.
 
In the years since, however, I have marveled at my youthful lack of foresight and prudence. Why did I assume that I was impervious to the misfortunes that befell others, like accidents and illnesses? Answer: Youth is like that. Nothing and no one prodded me to think cautiously about the future. Or to consider that I might bear some responsibility to pay for my own health care now were I to need some later. Like millions of other young Americans, I took enormous risks with my health. But that will begin to change soon, and it is a change I applaud.
 
In my blogs and other writings for America, I have strongly supported health care reform. And if you have followed my blogs, you know that I would have preferred a “public option” to increase competition and keep coverage as low as possible. Now that the health care bill has passed, though, I am happy it will address this particular issue, among others. The new law will require all adults, including young adults, to buy health coverage or pay a penalty. Most Americans will continue to be covered through employer-sponsored plans. But young people who have been opting out, will have to pay a penalty to do so in the future. Part of the reasoning behind it is that other taxpayers already pay for the treatment of the 35 million uninsured Americans. It’s only fair that every adult who can contribute something. Young people also pay lower premiums, which are based on age, but their contribution increases the general pool, which lowers the premiums all pay.

In my view, it is good for society to confront young people with the very real possibility of illness and accident in this way, to help them face their own mortality, which is a vital part of maturation. And it is good to cultivate among the public, beginning with the young, the habit of paying up front and regularly for goods that benefit us all—goods like health care. We are generationally interdependent, a fact this practice makes clear.

Finally, the law will provide ways for individuals of working age to find affordable coverage whenever they are between jobs or unemployed. After a tendentious, yearlong battle in Congress, the law will soon provide the possibility of continuous, affordable coverage.

Karen Sue Smith