San Francisco Chronicle June 13, 2011

People in their early 20s visit the emergency room more than any other group of Americans except the elderly – yet they are the least likely to have health insurance.

Now, as millions of young people step off the graduation stage and into real life this summer, many are confronting the crucial question of how to find coverage.

Changes in the federal health care law are offering them more options.

“Most college students don’t really think about health care,” said UC Davis student Rajiv Narayan, a campus activist who helps college students figure out their health care options. “Part of it is because we’re young … and most students aren’t really responsible for their finances.”

One in three Americans between ages 19 and 25 has no health insurance – the highest rate of all age groups – according to 2010 U.S. census figures. And that means many avoid going to the doctor: Forty-five percent of young adults delayed getting medical care last year because of the price, a Commonwealth Fund report released last month found.

But that could change in the wake of health law reforms approved in Congress last year. While some of the changes won’t take effect until 2014, others are already in place. One of them allows people younger than 26 to stay on their parents’ insurance unless their employer provides medical coverage.

Insured expected to double

About 600,000 young adults have taken advantage of the option so far, a number that could soon double, says the U.S. Health and Human Services Department. Insurers have also reported strong response to the policy. Officials from Kaiser Permanente, for example, said about 90,000 young adults across the country have enrolled in their parents’ Kaiser health plan. Blue Shield of California, which is based in San Francisco, added 22,000 dependents by the end of March.

And WellPoint Inc., the nation’s largest insurer, reported that its membership grew by about a third in the first quarter – about 280,000 new members – because of the new coverage to age 26.

Paula Villescaz, who graduated from UC Berkeley this spring with a degree in political science, doesn’t have that option because her mother is a single parent without health insurance.

But Villescaz, 22, who was diagnosed last year with a rare form of cancer, believes many other aspects of the law will help her.

Beginning in 2014, insurers will no longer be able to deny or limit coverage to people with illnesses or a history of medical problems. In the meantime, some people may be helped by a new federally funded high-risk insurance pool offering coverage to those who are medically uninsurable. Only those who have been uninsured for at least six months qualify.

“Long term, this health care bill does an extraordinary amount for me,” said Villescaz, who was diagnosed with Ewing’s sarcoma, in which cancer cells are found in the bone or soft tissue. “A few years down the line I can’t be denied for a pre-existing condition.”

Aaron Smith was a law student in 2009 when he co-founded Young Invincibles in Washington, D.C., an advocacy group to help people like Villescaz join the debate over national health legislation. Smith said young adults want health insurance but can face difficulties buying it on their own.

Highest rate of ER visits

“Young people go to emergency rooms more than any other age group under age of 75,” Smith said. “People want to choose a plan with a low premium – but then they discover when they actually get sick, that high deductible plan means they’re spending a lot of money out of pocket even though they have health insurance.”

The group has created an online tool kit to help guide people through the potentially confusing process of buying coverage.

UC Davis’ Narayan helped develop the tool kit through his position as director of health care policy for the Roosevelt Institute Campus Network, a national organization.

“We wanted to make sure we made the material digestible so students aren’t overwhelmed,” said Narayan, adding that he recently received a firsthand education in health coverage when he needed an MRI.

Villescaz, who volunteers with Young Invincibles to encourage her peers to get coverage, got health insurance for the first time when she became a student at UC Berkeley, which requires it. Initially, she did not need to use her college health benefits often. But after her diagnosis, she learned the policy had a $400,000 cap, and she had to fight to get her $1.2 million in treatments covered.

After months of chemotherapy and radiation she is not only in remission, she graduated with her class. Much of the financial battle has been resolved, but she still owes about $15,000.

She’s had to turn down a job that did not offer health insurance, and the new law prohibiting insurers from rejecting people with pre-existing conditions is still three years away.

Still, she said, “I can’t even fathom what I would have to do had that not been in there.”