In those murky years between the end of school and start of a career, the paths that young 20-somethings choose often determine whether they will be covered by health insurance or not.
Take Lawrence mother Janice Friedman and her two children - a son and a daughter, one on each coast.
Her son graduated from college, went to law school and then straight on to a law firm. He has had health insurance all his life.
The daughter, well, that's a different story.
The former art student weny years in her 20s without health insurance. Pre-existing conditions kept her from being covered between undergraduate and graduate school. And now even after earning her master's degree in museum studies, her salary isn't enough to cover health insurance and the rent.
During the times her daughter is without coverage, Friedman holds her breath, hoping nothing goes too wrong. For a mother who has a long history with cancer, it can be nerve-racking.
"It is really scary knowing my kids may not have the kind of insurance they need over the years to identify the problems that may be passed on to them," Friedman said.
This month, the Kansas Health Policy Authority Board released a 21-point plan directed at reforming the state's health care system. Among their recommendations were two targeted toward those between the ages of 19 and 25.
¢ Allow parents to keep children on their family insurance plan through age 25.
¢ Develop an insurance plan for young adults with limited benefits and lower premiums.
The two proposals could pick up more than 15,000 of Kansas' 300,000 uninsured, the health policy authority estimates.
In Kansas, about one in five people between the ages of 19 and 24 do not have health insurance. It's a higher percentage than any other age group.
The health policy authority board's recommendations are intended for a demographic that still depends on their parents for support, have low incomes and are unaware of the importance of health insurance, the authority's policy director Barb Langner said.
"They don't realize how much liability they are taking on if a serious accident or illness occurs," Langner said. "They'll incur quite a bit of debt."
Last legislative session, state Sen. Vicki Schmidt, R-Topeka, proposed a bill that would have kept children on their parents' insurance longer. It went nowhere.
The pharmacist and mother of a soon-to-graduate college student has heard from plenty of concerned parents. Many of them are her friends.
"My goal is to get more people in that age group insured," Schmidt said.
Arron Atchison, a 21-year-old barista at Lawrence's The Java Break, said if he could stay on his father's insurance, he would.
Atchison can't afford health insurance. When he needs medical attention, he pays the full retail price at health clinics. Although he saves money forgoing insurance, Atchison is aware that it's a practice that could cost him someday.
"If I get hit by a car, I am going to be in debt for the rest of my life," he said.
Many of the students who use Kansas University's Watkins Memorial Health Center are still on their parents' insurance plans, have purchased the school's policy or are covered under teaching positions and other jobs. However, some go uninsured.
"If they are going to skip something, unfortunately, it is going to be health insurance," said Diana Malott, assistant director of KU's student health services.
At Health Care Access, one of two clinics in Lawrence geared toward the uninsured and low-income population, executive director Nikki King said the 19 to 25 age group makes up a small part of their patients. The age segment tends to be healthier than the more typical 35-and-over patient. But there is a risk.
"That is the scary point, if something chronic does crop up, there is going to be a significant expense. If there is an accident, there is a significant expense," King said. "That is kind of the whole point of insurance, those great big 'what ifs' out there. But, being young and healthy, they usually don't think like that."
Time to grow up
Not everyone agrees that children should stay on their parents' health insurance plan until age 25.
State Sen. Jim Barnett, R-Emporia, said 20-somethings should learn early the value of health insurance. The same age group doesn't hesitate to pay for car insurance or homeowners insurance, he said.
"One of the drawbacks of staying on a parents' plan, it really delays the notion or idea that young people should be insured and they should be planning to take care of themselves," Barnett said.
Barnett also believes the change would put pressure on small businesses, who would then be forced to drop dependents from their insurance plans altogether.
Ken Daniel, owner of Midway Wholesale and with the Topeka Independent Business Association, agrees.
He doesn't think it is fair that he would have to cover his own 23-year-old employees and someone else's 23-year-old employee.
Even though the age group is a healthy one, Daniel said that one car accident, time in rehab for substance abuse or a severe illness could raise premiums for all his 117 workers.
And, he said, plans for less than $50 a month provide protection in case of rare, high-cost medical expenses.
"Half of them aren't going to use it. They don't see the value," Daniel said. "I don't think putting them on others' policies is the answer."
The cutoff needs to be drawn somewhere when it comes to dependents, said Bill Sneed, a Topeka attorney who represents insurance companies. Many insurance plans in Kansas drop children from plans at age 23.
Young adult plans
Barnett, Daniel and Sneed don't have qualms with the health policy authority's proposal to create an insurance plan for young adults. The insurance would cover catastrophic medical expenses and some health prevention and promotion areas as well, Langner said.
The health policy authority board stipulated that health insurance should be affordable - in other words, about 10 percent of the young adult's income. The idea is based off a program instituted this year in Massachusetts.
Sneed said that insurance companies would be willing to provide plans for the age group, but that trade-offs have to be made.
"The more things you load into policies, the more expansive it becomes," he said. "Whenever we have gone down this road - and this has been looked at at least two times in the years I have represented the industry - it is not what you cover, it is what you don't cover that causes consternation."
That is what worries Corrie Edwards, executive director of Kansas Health Consumer Coalition.
"It could be a bare bones plan with an outrageous deductible, with no mental health coverage, no prescription drugs, nothing to the plan," Edwards said.
In the case of Friedman's daughter, who has managed to make it through her 20s uninsured and with no major medical mishaps, the health policy authority board's recommendations would have helped.
But Friedman believes the proposals are little more than stop-gap measures.
"Students seem to be taking more time. Kids don't grow up as quickly as they once did. They are staying in school longer. Certainly extending (parents' coverage) for a few years is something that is helpful," Friedman said. "But it is just a small piece of the big problem."