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ERs becoming last resort for young people delaying medical care

Andrew Montes

Andrew Montes Credit: Sheila Anne Feeney

Andrew Montes, 26, a dispatcher for a delivery service who lives in East New York, knows what it's like to forego needed medical and dental care.

After a violent bike crash in which he hurtled over the handlebars, he refused to seek medical care for the searing pain in his shoulder until it finally drove him into an emergency room a  year later. "They told me I fractured my clavicle," he said, shrugging as best he could.

Montes is in plenty of company. A Commonwealth Fund study released this month found that 30% of all 19-29 year olds and 50% of those in that age group without insurance did not visit a doctor or clinic when they had a medical problem. Sixty percent without insurance and 41% of all young adults reported problems accessing needed care. Vast numbers of young adults also admitted not filling prescriptions, skipping recommended tests, treatments or follow-up appointments and not obtaining needed specialist care.

While some young adults are unable to obtain insurance, others forego it even when offered by their employers (as Montes is doing now), gambling that they will save more money by forgoing premiums and co-pays than opting for costly coverage.
But when they lose that bet, “we all have to pay for it,” noted Dr. Lawrence Casalino, chief of the division of outcomes and effectiveness research in the Department of Public Health at Weill Cornell Medical College.
Not only do small, simple problems become dire, dangerous complicated and costly to solve when neglected, but “the ERs are the safety nets for these people hedging their bets (without insurance) when something bad happens,” said Dr. Patricia Carey, director of the Emergency Department at Roosevelt Hospital. And emergency rooms, she noted, are “the most expensive place to get care in the U.S.“

While young adults are generally a healthy group, many have chronic conditions such as asthma, diabetes or seizure disorders that, when ignored, can wind up as a costly emergency room visit — or worse.

“Lots of people die from asthma,” said Casalino, who recalled a young caterer who couldn't afford a new inhaler and nearly died from an asthma attack. Appendicitis is also common among young adults and at least one study demonstrated that uninsured people were more likely to have a ruptured appendix at the time of operation than insured people, noted Casalino — most likely because they delayed seeking treatment for their belly pain. A ruptured appendix is far more likely to result in a costly, prolonged hospital stay with rampant complications — and even death — than one that is taken out promptly.

Many young people who are in high-risk groups for STDs, trauma and injuries ("they're always falling off skateboards” noted Carey) are quite shocked to find bills of more than $1,000 when they succumb to an ER visit.

“Law prevents us from discussing costs with patients,“ lest a hospital be perceived as trying to dissuade someone from obtaining care, Carey explained. “It's like not telling you the price of a car until after you buy it.”

Young people “don't always make good decisions,” noted Carey and many interviewed by AMNY  acknowledged never paying their emergency room bills. Some  said they waited to obtain cursory medical and dental care in their far-less-costly countries int their or their parents' country of origin and hoped that they would be spared an accident or illness that required immediate, local treatment.

LeDeana Oden, 27, of Canarsie, has two emergency room bills totaling $2,700 she is slowly paying off at $25 a month. Oden dropped her employer-sponsored insurance more than two years ago because she couldn't afford the $200 a month in premiums. “It was just too much,“ with too many loopholes, said the assistant book store manager, echoing the sentiments of many other young people AMNY surveyed.

If the Affordable Care Act — which is now awaiting a decision by the Supreme Court — becomes law, young people like Oden and Montes will be mandated along with everyone else to buy health insurance or pay government-imposed fines. But Oden said she would like to know what kind of costs the private insurers will be mandated to cover. “My question is: What am I going to be getting for my money?” asked Oden.

Individual patients and physicians differ in their opinions of whether and what parts of the Affordable Care Act should pass Supreme Court muster and whether a universal, single payer system would be a more effective route to comprehensive coverage, but all agreed that a change is needed from the health care casino young people — and others — are playing in now. “The system is so tortuous. We have to do something,” said Carey.

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