Young Thomas Mahoney was everywhere. The twenty-one-year-old’s confrontation with the health insurance system made news across the country, thanks to an Associated Press story that was picked up far and wide—KCBS, the Pioneer Press, MSNBC, and The Washington Post to name a few places. The requisite anecdote about Mahoney told of his epileptic seizure and how he bravely turned down an ambulance ride to the hospital, opting instead to have his mother and girlfriend drive him in order to save money. It turns out that Mahoney had been uninsured since he was nineteen, when he lost coverage under his father’s policy because he was no longer a full-time student, the usual requirement for keeping kids insured. He couldn’t swing the premium—$1500 a month— to stay on pop’s policy, and his epilepsy made him persona non grata with other carriers.
After explaining Mahoney’s plight, the AP got down to the nut graphs, telling readers that he was one of 13 million people between age nineteen and twenty-nine who had no health insurance, and that states were passing laws to let young adults remain on their parents’ policies for a few more years—another chunk in the great piecemeal attempt at reform, and one that could keep another million or so people insured at least for another few years. So far, so good.
But what about Mahoney? How would the new laws help him? The AP didn’t say, but moved right into the classic “he-said she said” story structure. And in the end, the piece seemed to be more of a position paper for the insurance industry, inveighing against the reform approach.
The industry claims that under these reforms aimed at covering young people it would have to pay for care that these young people previously paid for themselves. This burden, they argued in the story, would increase premiums for others. The AP quoted spokespeople from the Blue Cross and Blue Shield Association and America’s Health Insurance Plans, a trade association that includes the country’s biggest insurers, who said a “better solution is to let insurers offer a mix of plans that appeal to young adults,” (which, of course, means more sales for their members). The wire service also quoted a spokesman for the Council for Affordable Health Insurance, which the AP did not identify but presented as a neutral observer. It is not. The Council is a trade group whose members are insurance companies selling individual policies and health savings accounts, the kind young adults are likely to buy. Not surprisingly, the Council promotes the positions of its funders—as it did in the AP story—and as a result helped to pass along the mythology surrounding coverage for this age group that the media ought to instead be piercing and clarifying.
The Council tracks health benefits mandated by each state, such as coverage for chiropractic services, maternity care, and orthopedic appliances, and for years has railed against such mandates on the ground that they cost too much. It now has a new one to fight against, the “slacker mandate,” which refers to states’ attempts to cover more young people. The term “slacker” is catching on in this debate, unfortunately, and it is sometimes used to imply that young people shirk their duty to buy insurance because they are supposedly “immortal,” believing they will never get sick and need it. The word is even seeping into the campaign vocabulary. Hillary Clinton used it last week in the Ohio debates, and from now on, we may hear it almost as much as we’ve heard the term “universal.”
The Democratic candidates do have reform policies for insuring more young people. One plank in Barack Obama’s platform calls for young people to stay on their parents’ policies until they turn twenty-five, and judging from their comments to the AP, insurance interests certainly will oppose it. Under Clinton’s plan, this group would have to buy insurance as part of her individual mandate. McCain’s health proposals don’t address the issue.
Robert Nelb, a Yale senior who writes a health column for the Yale Daily News, recently offered some thoughtful observations and showed what journalists should examine as coverage for young adults floats to the top in the campaign debates. “We’re not slackers,” Nelb wrote. “We’re just students hoping for a chance at a healthier future.” He said he preferred to call states’ efforts to cover more young people an “opportunity option” that gives young adults more flexibility and freedom to become productive members of the workforce at a critical time in their lives. He notes that not every young person lands a job in investment banking and gets Cadillac coverage from Merrill Lynch. Countless others are doing public service, or are working for nonprofits, or have jobs that don’t offer coverage. Often their salaries are so low they can’t afford even the most basic policy. (The AP story did note that new entrants in the labor force are more likely to work for companies without insurance, but buried the point in the last paragraph.)
It is hard to get a job with good benefits when you are young. And yes, young people do get sick. Others are just unlucky and have conditions like epilepsy or heart murmurs that are not of their own making. The underwriting manuals for health insurers have long lists of conditions that disqualify people for policies.
The AP story did not dig into what young people should do if they don’t qualify or can’t pay for the mix of policies the insurance industry says it is designing for them, and we can only guess how Mahoney has fared. Has he gotten a job with good coverage? Did he qualify for a public program for those with rock-bottom incomes? Or is he still uninsured, hoping that he doesn’t get sick again, and that somehow the election will bring about a solution for his problem? It might help if the press clarifed his health-care problem, and that of so many of his generation.