So even though the full-time sales clerk from Baltimore could get health insurance from his employer, RadioShack, Stokes figures he can find far better ways to spend his cash.

Health problems "aren't coming up yet, so it's not much of a priority," he said.

In the debate over health care reform, Stokes and his peers are known as "invincibles," strong and healthy young adults who have no experience with wallet-crippling illness and feel they have no need for coverage.

They're also the most likely to be affected by the reform effort that President Barack Obama insisted in Wednesday's prime-time address to Congress is crucial to the future of the economy.

Adults ages 18 to 34 comprise more than half of the nation's uninsured. Under the various plans before Congress, they would be required to get health insurance or face penalties if they refuse.

While young adults supported Obama in huge numbers during last year's election, they have been relatively quiet about his quest for health reform despite the stakes involved. Noisy town hall meetings last month drew older crowds. Polls show that young adults are ambivalent about the need for reform and are generally paying less attention than their parents and grandparents. It is unclear whether Obama's address swayed many of them.

"Many folks in their 20s are pretty apathetic about health care in general, because they think, 'I'm not going to get sick,' " said Matthew Celentano, deputy director of the nonprofit Maryland Health Care for All.

That's dangerous, he said, because more than half of bankruptcies are health care- related. "You have a 23-year-old who gets in a car crash and is suddenly looking at $500,000 in medical bills. It happens all the time, but they don't think in those terms. They're really a forgotten sector."

The disconnect worried Jovany Andrade enough that he helped organize a health care forum at the University of Maryland, Baltimore last week. The 30-year-old pharmacy and public health student recalled his own indifference to health issues during his undergraduate years.

"I think we're going to look back in 10 years and realize this was a historic time," he said.

Insurance companies are hungry to sign up invincibles: Premiums of young people who don't need much care mean money that can be spent on those who do.

While some analysts say mandated insurance would place financial burdens on the young and healthy, others say they would be helped by proposals to subsidize those with lower incomes and to allow them to be covered longer under their parents' health plans.

Stokes, for one, would not be upset if Obama's plan mandated that he buy health insurance. He knows he needs to grow up a bit and take responsibility for himself - and being insured would be a step in that direction.

"I've known that's something I need to take seriously, so I'm glad he's enforcing it," Stokes said. "I wouldn't mind."

However, many young adults say they have gone uninsured or minimally insured out of necessity, not choice. Many entry-level jobs do not offer insurance, and private plans are expensive. Presented with a choice between crippling their budgets and betting that they will remain healthy, young adults reluctantly go without insurance.

More than one in four adults between ages 18 and 34 were without health insurance in 2008, according to a census report released Thursday. They account for 55.1 percent of uninsured Americans, and the percentage is growing, up from 53.8 percent a year earlier.

When Chaundra Scott graduated from college, her mother's insurance dropped her and she could not afford COBRA coverage. The Hanover native found a social work job, but it offered no health benefits. So for three years, she went uninsured.

Scott suffers from asthma and eczema and said that while uninsured, she had to go to the emergency room four or five times a year for treatment.

"The debt piled up from me not paying my bills," she said.

Scott looked into private insurance but found that many carriers would not accept her because of her chronic conditions. Others were prohibitively expensive.

"It was a very difficult time," she said.

Scott, 27, is now a student at the University of Maryland School of Social Work and has health insurance. But her credit rating is still hurt by the debt she accumulated while uninsured. She favors mandated health coverage because she does not want others to share her experiences.

"I like the idea of everyone having insurance," she said.

Her classmate Sonali Nijhawan isn't so sure. It would be nice if everyone had good health insurance, Nijhawan said, but mandates give her pause.

For years, Nijhawan carried low-cost insurance in case of catastrophe but was reluctant to use it because of high co-payments. She did not see a local doctor when she hurt her shoulder or when she was banged up after being hit by a car. She relied instead on telephone advice from her uncle, a physician.

Now that she has insurance, Nijhawan, 26, goes for checkups every six months and calls her doctor when she feels sick. She laughed when thinking about the risks she took while carrying minimal insurance.

"Whatever. I don't need it. I won't get sick," she said of her mentality in those years. "My parents, they were the ones who were very anxious about it."

Nate Mook is just 27, but his growing online technology publication, BetaNews, already has 10 employees around the country. Last year, the Baltimorean tried to get group health insurance for his small business, figuring that it was the right thing to do for his mostly young workers, only to learn how difficult and expensive the undertaking would be.

When he first tried, the wife of an employee was pregnant - a pre-existing condition that would have made everyone's premiums soar. When Mook tried again, he had a 63-year-old employee whose age would have skewed premiums. In the end, he paid his employees a little extra to buy their own insurance.

Now, many of his employees are just like he is: young, healthy and underinsured. Mook pays about $150 a month for his high-deductible policy, which covers one dental visit a year and has other limited benefits. He tries not to think about what would happen if he got sick.

He supports Obama's call for everyone - especially those in his age group - to get insurance. "We don't let people drive on the road without car insurance," Mook said. "Obviously, it's your personal health and it's up to the individual, but if it's a low-cost option ... having a little bit of an upfront requirement for cost will improve the system for everyone."

Evidence from national opinion surveys is mixed on the degree to which younger Americans are embracing Obama's biggest domestic initiative, which the president is attempting to jump-start this week.

A Gallup poll completed this month showed respondents ages 18 to 34 evenly split when asked whether they wanted their representative to vote for "a health care reform bill," offering less support than Americans ages 35 to 54 who might also be among those likely to feel squeezed by health care costs

Another national poll, completed about the same time by the Pew Research Center, found that those younger than 30 were more likely than other Americans to favor "the health care proposals being discussed in Congress."

Young adults (younger than 30) were also more likely than other Americans to say that both they and the country would be better off if the Democratic proposal became law, the Pew poll found.

The survey also found that young adults were less likely to be following the health care debate closely. Only about 1 in 3 adults younger than age 30 said they had heard a lot about health care, compared with a clear majority of those older than 30, according to the Pew poll, completed in late August.

Suzanne Gilbert, 25, a Celentano colleague at Maryland Health Care for All, said she has friends who have put off having babies because they cannot afford health insurance. Another uninsured friend recently paid $5,000 after having an appendix removed. Despite such examples, she said the health care debate leaves many young adults confused.

"You're used to your parents taking care of it and you don't really know how it impacts you," Gilbert said. "Then you realize how hard it is to find an affordable option. We're used to just Googling something and having the answer be right there for us. But you can't Google this."

By Childs Walker, Stephane Desmon, and Paul West

Baltimore Sun, September 11, 2009