Young people often criticized as whiny, entitled and irresponsible, may now have the most clout in one of the biggest overhauls of the country's health system ever.
Enrollment in President Barack Obama's landmark health reform plan began this week and particular interest is being paid to the country's 19 million uninsured young people, who range in age 18 to 34 and are viewed as key to the legislation's success.
Young healthy people need to buy into the system to help balance the cost of caring for an older population with more health problems who are likely to sign up with less prodding.
"We need a diverse group of people in plans to keep rates reasonable," said Kathy Westcoat, CEO and president of Health Care Access Maryland, a group helping people enroll in health plans. "If all the sick people sign up and not the healthy people, it could affect rates."
Convincing young people could take work.
The so-called invincible generation is often in prime health running marathons, trying Crossfit and other fitness trends and eating anything they want without gaining a pound or spike in their cholesterol. Doctors and regular checkups may not seem a priority and many may believe they can go without.
"They may have a mentality that it is not going to happen to me," said Peter Beilenson, who has started the health co-op Evergreen Health.
Life may get in the way of coverage for those who believe they need insurance. Do they pay the student loan or buy insurance? Can they truly afford insurance if they are just starting out in careers and can barely afford the rent?
A recent poll by the Robert Wood Johnson Foundation and the Center for Studying Health System Change found that convincing young people that health insurance is "a good deal" will have to be a priority.
"They will have to pony up," and decide "whether they think they need it," said Andy Hyman, a senior program director with the Robert Wood Johnson Foundation.
Aaron Smith, executive director of Young Invincibles, a national group working to enroll young people in health plans under reform, said most young people want insurance.
"The vast majority know health care is a priority; it's the question of cost," he said.
Smith's group has found that most young people will qualify for subsidies or free insurance under Medicaid based on their incomes. Many have already been able to get on their parents' plans under a provision that allows them to stay on until age 26.
But like many Americans, young people are having a hard time understanding the details of reform and weeding through misinformation. Many aren't aware where they sign up for insurance or how to figure out what it will cost them.
In Maryland, they can sign up on a state exchange, called Maryland Health Connection, that works much like a travel website. Calculators on the site will help determine what subsidies they may qualify.
One group believes the health exchanges may not be the best place for people to buy insurance. Generation Opportunity, a conservative group funded by the Koch brothers, is using provocative, and some say misinformation-filled ads, to tell young people to diss Obamacare.
"We are not advocating young people go without insurance," said David Pasch, the group's communications director. "There are plans available on the private market that may be better. I think young people should look at all health care options available to them if they are going to make the smart decision."
Obama tried to appeal to some of the younger generation last week, telling 2,000 students at Prince George's Community College they could sign up for coverage as easily as buying a "a TV on Amazon."
Health care plans will hit spots where young people frequent, including college campuses and festivals.
Another group, Healthy Howard, will use Facebook, Twitter and other social media strategies to reach that generation.
The University of Maryland System will also have various programs at its campuses, where they believe 25,000 to 30,000 students don't have health insurance.
Some young Marylanders tell The Baltimore Sun about their experiences without health insurance and what health reform means to them.
When funding for her AmeriCorps job ended in July, so did Kafayat Lawal's health insurance.
Through AmeriCorps, Lawal worked for the non-profit Central Baltimore Partnership, a coalition of universities, nonprofits, neighborhood groups and property owners that work to revive Baltimore neighborhoods. The group kept her on contract until last month, but didn't provide insurance.
Lawal, who lives in Baltimore, got a letter shortly before her coverage lapsed saying she could pay out of pocket to continue it.
"I never looked to see how much it is," she said. "It's not the first thing on my mind. Health is something that I really don't think about."
What is on her mind is paying off debt, finding a job and getting through graduate school. She doesn't think she could afford to pay for insurance on her own.
"I don't make a lot and I surely didn't make a lot with AmeriCorps," she said.
Lawal is too old to get on her parent's plan and said the student health plan offered at Morgan State University, where she is pursuing a graduate degree, was too expensive. She didn't want to take out additional loans to cover it.
She knows that logically health insurance is important and would love to have it if she could. But right now it seems more like a luxury.
"I know it would be even more expensive if something happened to me and I wasn't covered," she said.
Plus, Lawal said, she doesn't have allergies, asthma or other ailments where she needs to see a doctor regularly. The last time she went to the hospital was at age 6, when she had tonsillitis. She eats right and exercises regularly.
"I am betting on the fact that I stay healthy and won't have any problems," Lawal said.
Lawal said she has heard all about Obamacare and may look into health plans offered under the law, especially if she doesn't have luck finding a job.
But once again it will come down to price.
"It would have to be something that I could afford to pay for," she said.
Andy Klotz had to stop taking one of the prescription drugs he needs for depression and anxiety when he lost his full-time brewery job – and his health insurance – in January.
The medicine costs about $300 out-of-pocket and is something the 31-year-old Baltimore resident just can't afford.
He has since gotten two part-time jobs at a wine shop and with a distillery. He doesn't yet qualify for insurance at either.
He has tried to look for other, more affordable ways, such as exercise, to manage his depression and anxiety. His goal was to eventually stop taking the medication. Klotz just never knew he would have to do it so quickly. Luckily, his psychologist charges a reduced rate for visits.
Klotz had insurance growing up and visited the doctor regularly. As an adult, he has been without insurance more than he has had it.
Obamacare and the possibility of getting coverage again is refreshing for Klotz.
"I want reform to happen," he said. "Hopefully, I will finally be able to get a decent plan."
Sometimes, the idea also seems to be to good to be true.
"I am excited about it, but then start to wonder if it is false hope," he said. "You don't want to get too excited in case it doesn't happen."
Affordability is still a concern for Klotz. A couple hundred dollars a month is about all he can spare. And that will really cut into his lifestyle, Klotz said.
But he knows as he gets older health insurance is more important than ever. Klotz is pretty healthy now, but knows that may not always be the case. Since getting married, he feels more of an obligation to take care of himself for his wife.
"I am in my 30s now," he said. "I know there comes a time where you can't go without it. When you're younger you're not as worried about it."
Breha Brehon found out she no longer had health insurance when she went to fill a prescription.
The second-year psychology major at The Community College of Baltimore County was caught off guard when the pharmacist said her insurance had been denied. She thought she was covered under her dad's plan.
Brehon had to pay $90 dollar out-of-pocket for her medicine – a lot of money for a college student with a limited income. The Baltimore resident was used to paying $10 with insurance.
Her dad later called the insurance company and was told that 18-year-old Brehon was too old to be on his policy.
Under Obamacare, adults can stay on their parent's plan up to age 26, but under certain circumstances there is an exception for grandfathered plans in place before March 2010. They don't have to offer it if the youth can get insurance through an employer. That exception disappears when health reform is fully implemented Jan. 1. In the meantime, most insurance companies have already begun to allow young adults to enroll on their parents' plan.
Brehon is one of the unfortunate ones that may have gotten caught in the transition. But she's not sure. She works part-time in the bakery of a grocery store, but doesn't think she qualifies for a health plan there. She is confused why she would have been dropped by her father's plan.
She would like to get coverage, but doesn't know where to start or if she could even afford it.
"I don't know even know how to look for insurance," she said.
She's heard all about Obamacare, but didn't think about it herself until she became one of the country's millions without insurance. But once again she doesn't know how to navigate the system. She plans to do some more research and see if she can get eventually get back on her father's plan.
All she knows now is $90 for medication is not in her budget.
"It was unfair that I just got kicked off," she said.
Ghulam Mojadidi was excited when he recently found out he qualified for a state program that provides health care coverage to low-income adults.
The 28-year-old from Baltimore had been without insurance for a long time and looked forward to finally going to see a doctor regularly and not having to worry about what he would do if sickened.
Primary Adult Care had only limited coverage of primary care visits, prescription drugs, emergency room bills, and mental health and substance abuse treatment. It did not cover hospital stays, or most specialty services. But it was more than what Mojadidi had.
Then he was devastated after a couple of months on the plan to get a letter from the state that he no longer qualified.
The restaurant server and student at The Community College of Baltimore County was back where he started – with no insurance.
He doesn't know why he didn't qualify. Although his salary as a server can vary greatly from week-to-week based on tips, he estimated a higher salary on his application even though he could and probably would make less. He didn't want to ever get in trouble for putting down a low salary and he ended up making more. But Mojadidi believes it also might have made him appear to make too much to qualify for the program.
Now, he is thinking about health reform as a way to finally get coverage. But he worries he won't be able to afford that too.
He's heard a lot of bad talk about reform – that premiums will be too high. Mojadidi said he will do his own research and find out for himself. It's worked in other places, he said.
"That's what is better about Canada," he said. "They have health insurance for everyone."
Mojadidi worries what he would do if he got really sick. So far, he hasn't had any major health complications. But he has a brother who has a hernia but can't afford to see a doctor.
"It would be nice to be able to go to a doctor," he said.
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