Steve Kurpiewski gets paid to fix bikes. His fingers are grimy from tuning derailleurs, truing… Steve Kurpiewski gets paid to fix bikes. His fingers are grimy from tuning derailleurs, truing wheels and greasing chains.

Every day, Kurpiewski rides to and from work at Iron City Bikes, a bike sales and mechanic shop on South Bouquet Street. He makes sure to follow traffic laws as closely as possible, using bike lights and turning signals.

Because if he were to get hit by a car, Kurpiewski would be thousands of dollars in debt.

Kurpiewski, 24, is among the nearly one-third of young Americans which has no health insurance. People aged 19 to 29 are the least insured age group in the nation, according to a U.S. Centers for Disease Control and Prevention report.

“I am at a bit of a higher risk for needing medical care, but that’s just a risk I’m taking,” Kurpiewski said.

Young people are the least likely age group to have health insurance, and when they do have it, they have problems accessing it. Policy makers, researchers and the White House have acknowledged that if Washington aims to provide coverage options for the uninsured, lawmakers must figure out how to target that age group.

Lacking access

Karyn Schwartz, a senior policy analyst at the Kaiser Family Foundation in Menlo Park, California, published a 2008 report that found that young people are more likely to be uninsured because they face the same problems that affect the average uninsured population ¬— and those problems affect young adults more.

“The uninsured tend to be low-income, and even though most are in working families, they don’t have access to employer-based health insurance or can’t afford it,” Schwartz said.

The Kaiser Family Foundation report found that while 31 percent of young people are uninsured, only 18 percent of non-elderly people overall lack insurance. Most elderly people qualify for health care under the Medicare system.

Schwartz said that one option for young people is to purchase a special “catastrophic” plan that has minimal coverage.

“Some young adults can purchase these catastrophic plans with minimal coverage, but it’s hard to know if you would have a benefit that would also protect you if you got sick,” she said. “If you got cancer, the drugs you needed [might not] be covered. Or it may not cover maternity care.”

Employer-based health care

Dr. Scott Tyson, a pediatrician at Pediatrics South in Pittsburgh, said many of his patients lose their health coverage after they turn 19 or after they graduate college, when they are usually no longer covered under their parents’ plans.

Tyson said many of his patients come from affluent areas, so their parents can afford to help them pay for insurance or to send them to college. But at his McKees Rocks office — located in a less affluent area of Pittsburgh — his patients are more likely to get jobs after college, and therefore, less likely to have health care.

One of the major problems that makes low-income and young people less likely to have health insurance is that small businesses have difficulty purchasing coverage for their employees and companies with many young workers are less likely to offer insurance, Schwartz said.

Large firms can self-insure — they can hire an insurance company to administer a benefits plan — but as the firms get smaller, the situation looks more like the individual market, she said.

“If you have 100,000 workers, chances are it will even out,” she said. “But if you have four workers and one of them has cancer, that’s a huge cost to an insurance company. The small-group market just doesn’t work as well as the large group market.”

Young people are more likely than older people to work at smaller firms and small businesses, because they tend to work entry-level or wage-level positions before working their way up. This trend decreases with an increase in education. About 15 percent of college graduates are uninsured, Schwartz said.

Most of the young people who are uninsured are employed either full-time or part-time, according to the Kaiser Family Foundation study. The study found that 56 percent of uninsured young adults work full-time, while 15 percent work part-time, 8 percent are full-time students and 21 percent are unemployed. For adults aged 30 to 64, 61 percent are full-time workers, 12 percent work part-time and 27 percent are unemployed.

Kurpiewski graduated from Pitt last year with a creative writing major, but he said he isn’t sure what he will do with his degree.

He said it’s often hard for small businesses to pay for health care. Many of the people who work at small businesses can understand the problem.

“If you work at an intimate level with the business owner, you can see finances a little more,” he said. “[Providing] health care for everybody would be a ridiculous cost.”

The White House health care reform website, www.healthreform.gov, issued a series of promotions saying how its health reform plan could help various demographics, including young people.

“The typical young adult frequently changes jobs, moves or holds part-time or temporary jobs,” the site says. “Under reform, it doesn’t matter — you will always have choices of quality, affordable health insurance.”

“Health reform will offer health insurance to those without job-based coverage and provide premium assistance to those who still can’t afford it,” the White House website says.

Tyson, the pediatrician, is a member of Physicians for a National Health Program, a national group that lobbies for single-payer health care — a system in which the government would collect money to pay for health care, similar to the systems in the United Kingdom and Australia.

Tyson said he became “disillusioned” with the current health system about 10 or 12 years ago.

“I think I started to realize that there had been a dramatic change in health care, and a lot of people weren’t getting services that they needed,” Tyson said.

Most people get their insurance through their jobs, he said, and this presents a problem for many people, especially in a struggling economy. He said this is a main reason why he would like a national health program.

“It would be as if you had a fire in your house, and you’re not allowed to call the fire department to get you out,” Tyson said. “Some of it’s so goofy, you can’t believe it.”

The possibility of reform

Many interest groups currently lobby Washington, including reform critic America’s Health Insurance Programs, which advocates on behalf of health insurance companies. Young Invincibles lobbies for the opposing position: health care reform that could help insure young adults.

The U.S. Senate passed a multi-billion dollar health care reform bill on Dec. 24 that awaits negotiations with the White House to earn President Barack Obama’s signature. Schwartz said the effects of the reform proposals are yet to be determined.

One thing that will definitely help uninsured young people is the proposal to expand Medicaid coverage, Schwartz said. According to her report, Medicaid, a public plan aimed at low-income families, does not apply to 74 percent of young adults. Low-income adults are only eligible for Medicaid if they are pregnant, a custodial parent or disabled, according to the report.

The House of Representatives passed a proposal that would expand Medicaid coverage to people who live at 150 percent of the poverty level ¬— currently around $17,000 annual income. Schwartz said the proposal would cover 61 percent of young adults.

“Medicaid has very low premiums, and historically, has a very comprehensive benefits package,” she said.

Currently, federal law mandates that when young adults turn 19, they no longer qualify as dependents on their parents’ health insurance programs unless they are in college. Obama has proposed extending that age to 25.

Many states, including Pennsylvania, have passed laws that would allow private insurers to cover young adults under their families’ insurance packages until age 30. Although these laws have gone into effect, Schwartz said they don’t necessarily cure the problem. The laws will only help those whose parents have employer-sponsored coverage.

“It is also unclear how ‘dependent’ will be defined and who will qualify,” she said.

According to her report, increasing this coverage will help full-time students most. But young people who don’t attend school or are married, attend school part-time or live in a different state than their parents are less likely to benefit.

Self-insured employer plans, typically used by large firms with more than 500 employees, aren’t subject to state regulations on insurance, Schwartz said. One study estimated that 55 percent of employees have these kinds of plans.

The federal insurance plans for reform, similar to the state-based initiatives, also remain unclear about exactly how they will help younger adults. Schwartz said that this depends on how much age rating will be allowed — to what extent insurance companies can vary premiums based on the policy owner’s age.

If the legislation allows for a lot of age rating, premiums will be less for young people. If not a lot of age rating is allowed, premiums will be more expensive for that age group, Schwartz said.

The psychology of being young

Not everyone blames lack of insured youth on employment or cost. Mary Ahn, who works at Medicaid’s national office, said she thought the lack of insurance was mostly caused by the “arrogance of youth.”

“When you’re in that age range, you don’t typically have a lot of health issues,” Ahn said. “I think young people typically don’t understand how critical it is, how vulnerable everyone is, and also, there’s a lack of availability.”

Kurpiewski said he isn’t too concerned about health risks at this stage in his life — he has gone a year without health insurance and hasn’t needed health care. He’s not even sure how much a program would cost for him.

He pays for rent, utilities, food, car insurance and phone bills.

When he compares himself to people who make $40,000 per year, Kurpiewski said he realizes he’s “not really comfortable.”

He said that many of his friends are “in the same boat” as he is. One of his friends doesn’t want to get married to his longtime girlfriend because he is afraid she will incur his medical debt, Kurpiewski said.

Tyson said he disagreed with the notion that young people don’t have health care because it’s not a priority for them.

“I think frankly, that’s bull, and it’s insulting to people in the younger age population,” he said.

“If [health insurance] was affordable or reasonable, I think people would purchase it,” he said. “How do you know when you’re 22 that you’re not going to have a catastrophic event?”

Tyson estimated that an average young person with no preexisting conditions and was healthy might pay $280 with a $1,000 deductible. He said that women would pay more, because of the risk of getting pregnant.

But for people with a more complicated medical history, premiums cost much more, he said.

“It would not surprise me at all if a female with diabetes would pay $800 to $1,000 [per month],” he said.

Tyson said many people transitioning between jobs or waiting to get a better job and health insurance probably think they can survive six months or so without insurance.

“But if you get hit by a car in that six months, you’re screwed,” Tyson said. “Financially, you’ll be wiped.”

Kurpiewski said he is currently saving money to move out of Pittsburgh in the next year, so he does not plan on finding health care coverage anytime soon.

He reasoned that bike injuries often heal themselves.

“If you get a broken collarbone, for instance, it will heal by itself,” Kurpiewski said. “Unless it’s severe.”