WATERLOO -- The pile of unpaid medical bills is an illness unto itself.
Chronic health conditions are never cheap, but Sarah Posekany's Crohn's disease is particularly costly.
In four years, she amassed $70,000 in medical bills, without any health insurance to ease the burden.
In February, she declared bankruptcy. At 22 years of age.
Posekany is part of a growing population -- adults ages 18-29 without health coverage.
Uninsured Americans come in all ages, but young people are disproportionately represented. Thirteen million young adults lacked health insurance for all or part of 2002, according the U.S. Census Bureau. While those same adults make up just 17 percent of the U.S. population, they represent 30 percent of the uninsured.
Posekany said her Crohn's disease is a financial burden that has stalled her life. She has only one semester of college under her belt and she still lives at home.
"I have to concentrate on my health before I can concentrate on my future," Posekany said.
Why so many go without
Young adults are the most likely group other than low-income Americans to go without health insurance.
To stay on their parents' plans past age 18, they must be full-time students. If they work, they are more likely to have temporary, part-time or low-paying jobs that either do not offer insurance, or carry premiums that take too big a bite out of their meager paychecks.
"The cost of health care is just outrageous. I'm trying to pay for college and health care, but I have to have a full-time job just to get and pay for health care," Posekany said.
Posekany always thought she'd graduate from high school, go to college, become a nurse, and live a happy, relatively debt-free life.
At age 15, she was diagnosed with Crohn's disease. There is no cure.
Crohn's attacks the entire digestive track. An untreated flare-up makes eating painful, causes diarrhea, dehydration, exhaustion and rapid weight loss.
During the last semester of her senior year at West High School, Posekany got sick, and stayed sick for so long she was unable to start college in the fall with her peers.
Because she was 18 and not a full-time student, she was dropped from her parents' insurance.
Her parents still carry some debt because of her illness; and she is in debt again, even after declaring bankruptcy.
"When I can't receive or pay for medication, I get extremely sick. I can't eat, I lose a lot of weight and my body shuts down to the point where I need to go to the hospital and get IV fluids," Posekany said.
That's happened at least twice each year she's lived without health insurance. The last hospital visit, in February, cost $4,500 for three days.
Treatment for Crohn's is costly. There are many pills on the market that can cost hundreds of dollars a month. The most effective medication available, Remicade, is administered intervenously and costs $1,500, plus outpatient fees.
People with Crohn's usually get Remicade every eight to 12 weeks, depending on severity. Posekany said it's the only medication that has ever made her feel normal.
Unfortunately, she hasn't received a treatment for more than a year. In the meantime, her prescriptions cost about $400 a month.
Posekany's case notwithstanding, young people are fairly low risk to insure. They tend to be healthier and more resilient than older adults. But, when a health issue does arise, they are likely to delay treatment. That can lead to bigger -- and costlier -- health problems down the road.
A 2003 survey by the nonprofit Kaiser Family Foundation found half of uninsured young adults had postponed seeking needed health care because of cost.
Heidi Shuberg, a 21-year-old University of Northern Iowa student, was without health insurance for a year and a half when she was enrolled only part-time. She upped her credits this semester and is in the process of getting back on her parents' plan.
A few months ago, Shuberg's tooth hurt. She ignored it because she couldn't afford a visit to the dentist. But the pain got so bad she had no choice.
An untreated cavity resulted in an infection, a root canal and days of antibiotics.
"It would have been hundreds of dollars cheaper if I'd just taken care of it," Shuberg said.
Young mothers also put their health care needs on the back burner, said Julie Bloom, the nurse manager for Covenant Medical Center's high-risk clinic, which serves mostly low-income and young, single mothers.
It is not uncommon for an uninsured woman to come in for a first appointment during her third trimester.
"We'll see problems then, like gestational diabetes, and it's so late in the game," Bloom said. "If they only would have come in earlier."
Orlando Hernandez, 23, has never known a life with health insurance. Currently in his last semester at UNI, he grew up in San Antonio, Texas, one of eight children. His parents could not afford health insurance. But they lived close enough to their native Mexico that they could cross the border to receive health care for a fraction of what they would have paid in America.
Hernandez spent last summer in Cedar Falls, working construction. He doesn't have the best back.
"When it hurts, when it's aching, I can't take care of it," Hernandez said. "I just deal with it."
What can be done
Hospitals do try to alleviate the financial burdens of young patients. Both Allen and Covenant have patient financial advocates and social workers on staff, who educate young adults about their options for economic support.
The social worker's first step is to see if a patient is eligible for Medicaid. Most young people between 21 and 29 are not, unless they are pregnant or have a child under 19 years of age.
The next step for young adults is to apply for the equivalent of a financial scholarship, which at Covenant is called the Community Care Fund.
Like young adults in debt from medical treatments, that fund also is stressed.
From fiscal year 2003-04, Covenant saw a 65 percent increase in the number of people receiving Community Care support. There was a 47 percent increase in dollars allocated for Community Care. That translates to 3,340 people in Northeast Iowa receiving a total of $3.2 million.
Covenant expects 2005 to yield bigger increases in Community Care recipients and dollars.
There is a silver lining.
Arkansas congressman Vic Snyder introduced legislation last year that would permit states to cover low-income young adults under Medicaid up to age 23, with expansion financed in part by federal funds.
Senate Republicans have proposed financial incentives for colleges and universities that provide or require health insurance for full-time students, which already happens at some schools in Massachusetts, New Jersey and Idaho.
States also could raise the dependent age for young adults. Utah requires all insurance policies to provide dependent coverage up to age 26.
Posekany just got a job as a nurse's aid at Windsor Care Center in Cedar Falls. After six months of employment, it will pay for her to go to nursing school at Hawkeye.
She plans to be a surgical nurse for gastroenterology and wants to work with children who have Crohn's.
Posekany said the insurance coverage at Windsor is excellent; however, because it is a pre-existing condition, her Crohn's disease will not be covered until she has worked there a year. She is trying to stay healthy. If she gets too sick to work, her schooling and insurance will be on the line.
"I just wish this state or this country could help people out who needed help for the short term, not for the rest of their life," Posekany said. "I just need a little boost until I get through school, and then I can be a good Samaritan and pay for my own health insurance."
Stacey Palevsky can be contacted at (319) 291-1580 or email@example.com.