Young but Not Invincible
The current debate on health care reform and its rapidly changing policy landscape leaves open a number of problems and ignores or dismisses several populations. Understanding the current policy recommendations and the concerns surrounding them were the subject of a recent forum on the politics of health care reform in the United States, co-sponsored by the DSC Health Issues Committee on October 8. A series of speakers offered academic and practice-based perspectives on the Barack Obama administration and Congress’s most recent efforts to pass a reform bill that is rapidly dwindling to little more than new regulations on private health insurers and a health insurance mandate, which aim to close the widening gap of uninsured Americans and wrangle escalating health care costs.
Most uninsured people make too much money to qualify for Medicaid (less than $706/month for an individual; less than $1,217/month for a family of four) but cannot afford coverage on their own. Young adults occupy a unique niche in this health insurance demographic. Within the debate on national health care reform people between the ages of eighteen and thirty-four are continually labeled as “young invincibles.” The bill sponsored by Senator Bacchus (D-Montana) includes mandated health insurance for everyone with a discounted ‘young invincible’ policy for people under the age of twenty-five. A far cry from the left’s calls for a single payer plan, or centrist calls for a public option. Baccus’s bill offers little more than some basic tinkering with the for-profit insurance market. It proposes giving financial support for creating health care cooperatives and creating exchanges (regulated marketplaces) where small businesses and the uninsured can buy into government vetted health plans. There are regulations on what plans must cover, but these are rolled out in tiers (literally going from “bronze” to “platinum”) and maintain structured inequity in terms of access to care. These reforms will do little for most of the young adults here at the Graduate Center. We are far from invincible and most of us are not under any illusions about this. The label is problematic because it is inaccurate and it positions us unproductively and unfavorably in the health care reform debate.
The label “young invincibles” paints us unfavorably by describing us as willing risk takers when it comes to health coverage. It thinly cloaks our elected representatives’ assumptions that we don’t want health insurance; that we are actively choosing to remain uninsured; that we would rather spend our incomes on other things; and that we do this because we are somehow unaware of our own vulnerability. From this perspective, young adults are not only threats to our own health but we become a big piece of the escalating insurance cost problem. By not buying into the private health insurance system we fail to help disperse the costs that insurance companies pay for care, presumably because we don’t require the same amount of care that older adults do. If more young healthy people like us paid up for insurance, the argument goes, it would be cheaper for everyone. This logic is a paternalistic way of saying we are too dumb and reckless to do what’s good for us and too selfish to do what’s good for our country.
This is where the term young invincibles and the assumptions behind it become politically and practically unproductive. By positioning us as needing to be forced into buying insurance, it provides a rationale for legal mandates on having health care coverage, not for the altruistic goals of protecting us from illness, injury, and the threat of financial ruin before age forty—but rather to disperse risk for private insurers. Politically we are not at the table speaking for the care we need. We are used as bargaining chips nudged back and forth between politicians and the insurance industry. Forcing us to pay for health insurance is big leverage for getting insurers to lower premiums and accept people with pre-existing conditions. Practically speaking, our health care coverage is never discussed as serving us and the particular health care needs we may have.
We understand that we are vulnerable, we want care, but most of us can’t afford it! We get sick with everything from common colds to early cancers. We get hit by busses while riding our bikes and acquire sports injuries as we try to take personal responsibility for staying fit. We get depressed and struggle with addictions. And, we need and want preventive care. Women in this age bracket are in the prime years of fertility. We need access to health care so that we can have healthy pregnancies and families when we want them and have reasonable options for deciding what to do when we don’t.
Most of the young invincibles I know are troubled about not having health insurance but the options they are presented with are out of reach. At one point, when I was uninsured graduate student I found the nearly $200 a month New York State Family Health Plus Plan and the $250 a month Student GHI coverage unaffordable with my salary as a research assistant and teaching fellow. To qualify for free health insurance through the New York State I needed a pre-tax income of no more $800 a month. This is less than what most of my colleagues pay monthly in rent.
The debate about national health care reform is connected to a long-standing and ongoing struggle for health care at CUNY. This struggle is about more than the right to see a doctor. At CUNY, graduate students, and recently graduated part-time faculty, teach more than half of the courses offered—and are uninsured or underinsured. Our under- protected health is a major vulnerability to this university. As such it undermines the university’s mission of providing high quality education to poor and working class New Yorkers. Our underinsurance, the precarious position in which it leaves CUNY, and the death and resurrection cycle of the ‘public option’ are reflective of the troubling stance our society takes denigrating and underfunding all things “public’”
Unlike most universities, CUNY does not have a health insurance mandate. Supposedly, this is meant to protect students from the cost of paying into a university-wide health care system. In practice it means that CUNY is absolved of any responsibility for our health care and that our student fees cover the majority of the wellness services offered on this campus. As of last year, matriculated Graduate Center students who meet employment requirements are eligible for insurance as student employees of New York State. The coverage that some of us receive through the New York State Health Insurance Program (NYSHIP) was hard won. The Profession Staff Congress of CUNY, the Doctoral Students Council, the Adjunct Project, and the Graduate Center administrators, students and faculty who fought for this should be applauded. However, as it functions now, the NYSHIP agreement still leaves even those of us with coverage grossly underinsured and leaves adjuncts who are not matriculated students simply uninsured.
As chair of the DSC’s Health Issues Committee, I’ve had the unhappy privilege of trying to help students find a course of action when they encounter NYSHIP’s limitations. For example, if you are under forty, the plan only allows for $60 every two years for routine care. It provides no coverage for preventive care or diagnostics—like tests for sexually transmitted infections. The dental plan included only pays for mercury fillings, not composite fillings, which are less toxic. Unsurprisingly many students are hard pressed to find health care providers that accept our plan. Worse yet, many only become aware of its limitations after they exceed their annual, or biannual, allowances and begin receiving claim denials and bills in the mail.
Reflective of our position in the health care debate in Washington, at home within CUNY we are also being used to disburse risk. For a single person, our insurance costs New York State and CUNY about $100 a month. It’s cheap in part because it doesn’t cover much. It is also cheap because it allows the private insurers involved to enroll more young invincibles under the expectation that we won’t need, or want, much health care. It also allows both private insurers and New York State to dismiss our needs now that we have insurance that is considered better than
nothing.
The single payer, or Medicare for all, options have long since disappeared from our national debate. But, this option is the one most likely to address the health care needs of young adults in public institutions like CUNY. It could drive down cost by eliminating administrative expenses and leveraging economies of scale. It would ensure that working and non-working students and their part-time faculty instructors were covered when they got sick or had accidents. Delivered well, it could even begin to break down some of the stigma we place on public goods.
If you missed the October 8 forum and would like to know more about health care reform and how you can get involved in the national debate, the Student Health Committee of the Public Health Association of New York City is planning a health care reform teach in on this on October 22. The event will be held at Columbia University. For more information go to www.phanyc.org.
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