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STEVE INSKEEP, host:

Commentator Brittany Hunsaker of Youth Radio has not started her career yet, but she's already worried about health insurance. She grew up in Whitesburg, Kentucky, and is helping to break the cycle of poverty in her family by going to college.

She works plenty of hours to pay for school, but she doesn't have insurance.

BRITTANY HUNSAKER: My 19th birthday was a bittersweet occasion. That day, I officially aged out of Kentucky's insurance program for low-income youth.

As luck would have it, I developed a health problem almost immediately. Pain in my teeth spread to my head and neck, and headaches made it impossible to concentrate in my college classes. I couldn't see well enough to drive. Going to the doctor or dentist cost more than my weekly paycheck from a fast-food restaurant. I had to choose between oral surgery and textbooks that semester. Textbooks lost, but luckily I made it through that class.

When it comes to health care, I do have options - just not good ones. In the rural county where I grew up, it's not just young people who don't have health insurance. Adults, unemployed or underemployed in minimum wage jobs, are also without coverage. You can get health care there if you're in a dire situation, like if you're pregnant or recovering from drug addiction. I know a few girls who got pregnant just to afford a doctor's visit, or had another baby just to keep their health insurance.

I am not financially or emotionally ready to bring a child into this world, but I feel like I am being penalized for getting an education while others are rewarded for their reproductive capabilities.

My friend Willa Johnson is also in college and uninsured. Going to the doctor to check a cough is a luxury she can't afford. Last spring, she started feeling sick. By the time she went to the emergency room, she had full-blown pneumonia. A week later, Willa found herself in the emergency room again. She'd torn the muscles around her rib cage from coughing. Seven months later, Willa has not completely healed. Her cough is painful to hear. Still, she worries more about the bill collectors calling for those ER visits than her health.

My friend Brian Hobbs just graduated from college, and he's about to lose his insurance. He won't be able to afford the prescription for his glasses. What happens if he gets sick? Brian is scared he won't find a job that pays enough to cover rent and food, let alone annual insurance.

Looking at my own future, I'm worried that my health will keep getting worse, that my teeth will keep bothering me, that I'll keep ignoring aches and pains, and that I'll continue to just Google symptoms to see if things are serious enough to warrant a bill.

I grew up in one of the sickest communities in America, with the lowest life expectancy of any area in the U.S., lower than China or Mexico. Cancer, diabetes, addiction, obesity, depression all look like epidemics there, and that adds to my worry.

I don't think any position I'm going to get out of college will come with health insurance. I don't know a single friend from college who has a job like that. A sick workforce only intensifies an already sick economy. It's hard to work when you can't afford eyeglasses for your astigmatism, dental work for your rotting teeth, or medicine for pneumonia. We're constantly being told we are the future of the country, but we're starting out a step behind.

INSKEEP: Commentator Brittany Hunsaker attends the University of Kentucky at Lexington. Her essay comes to us from the Appalachian Media Institute and Youth Radio, and you can comment on it at the Opinion Page of npr.org.

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