Bill's Story

This is the fifth of a 6 week series entitled, "Summer at the County Fair". It is a synopsis of 6 hours I spent meeting and speaking with people who were visiting a county fair in western PA. Over the next few weeks you will see the human faces that mirror our national statistics regarding the uninsured and underinsured. Thanks to the Pennsylvania Health Access Network (PHAN) for their assistance in this series.

The mist of the late July morning stubbornly hung over the mountains of western Pennsylvania when I arrived in Punxsutawney, a town that proudly proclaims itself as being the “capital of weather”. Punxsutawney is home to the infamous character and Pennsylvania icon, Punxsutawney Phil, the immortal groundhog.  Known to the world every February 2, but revered by Pennsylvanians as the state mascot.  I’ve often wondered why this seemingly annoying “pest” has become so cherished and preserved.  As I explored the streets of Punxsutawney, I found a town enshrined in the legend.  The groundhog museum, dozens of groundhog statues scattered about the town and “Phil’s Burrow”, the place the groundhog calls home 364 days of the year.  Every February 2 however, Phil will emerge from his burrow in order to execute the 18^th century Pennsylvania German tradition of predicting the end of winter.  So guaranteed is this event that an entire town proclaims it, our state honors its actor and the nation tunes in each year to hear the results of an oversized rodent as he pursues his own shadow.  Predictable, Guaranteed, Expected, Certain and Secure-all adjectives that could describe Phil’s annual ritual.

As I left Punxsutawney and crossed the counties that lie in the northwest of Pittsburg, I thought about these values.  I thought about the guarantees of our culture.  Hours later I met Bill.  Bill is the full-time manager of the park where the day’s county fair was being held.  He is a 22 year old college graduate with a degree in recreation management.  He is uninsured.  At $23,000 a year, Bill explained to me that he had a choice to make each month between health insurance or food and student loan payments.  As he explained his situation my mind dizzied with confusion.  The quintessential guarantee that many of us have been promised for generations was being torn apart.  Wasn’t a college degree supposed to be our ticket to lifetime security? 

1.2 million College graduates can proclaim this reality.  The uninsured with a college degree now represents 9% of our youth population between the ages of 19-29[i].  So much for guarantees.  Unfortunately this number is only going to get worse as we embark on an economy that has fewer jobs and a job market that relies even more on part-time workers, subcontractors and temporary employees.  Additionally, if a young college graduate is lucky enough to get a full time job, they are less likely to be offered health benefits.  The rate of employer sponsored health care has been declining for the past decades[ii] .

The evolutionary changes in the dynamics of our workforce have left us with outdated guarantees, indicating the societal need for the Patient Protection and Affordable Care Act.  Under the PPACA, Bill can stay on his parent’s health insurance until age 26.  Those over 26 will be eligible for the individual exchanges that will provide them access to health care with guarantees of essential benefit.   Since most youth starting out in their careers fall in a low income bracket, many of them will also qualify for the premium tax credits.  Another reason this cohort has such a high rate of being uninsured is the perception that they are “invincible” and not subject to ill health.  While their rates of illness are lower than their older counterparts, access to preventive care that is now guaranteed by the PPACA will ensure that they enter later adulthood in a healthier and therefore less costly state of health.  Bill and his generation can also expect the other standard benefits guaranteed by the Patient Protection and Affordable Care Act such as medicalloss ratio, basic patient protections and rate review.

Like Punxsutawney Phil, our country has emerged from its burrow to realize that the season of old guarantees has changed. 

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[i] Schwartz, Karyn; Schwartz, Tanya,  The Kaiser Commission and Medicaid and the Uninsured.  Uninsured Young Adults:  A profile and Overview of Coverage Options.  June 2008

[ii] Cohen RA, Makuc DM, Bernstein AB, Bilheimer LT, Powell-Griner E. Health insurance coverage trends, 1959–2007: Estimates from the National Health Interview Survey. National health statistics reports; no 17. Hyattsville, MD: National Center for Health Statistics. 2009.