Laid off from his job at a computer software company in Philadelphia, Andy Szamody wondered where he would find health coverage.
His firm told him it would offer a temporary policy that would cost $212 a month. But "when you're not making any money, that seems like a lot of money," Szamody said.
The local unemployment office informed him of other options, but jobless benefits disqualified Szamody for the cheapest, a basic plan that covered doctor visits but not prescriptions for $30 a month. In the end, he opted simply to do without.
"I find the whole insurance thing totally overwhelming and confusing," Szamody said.
Szamody is one of an estimated 1.4 million Americans who lost insurance coverage over the past year due to layoffs. The total number of uninsured now stands at 41 million, according to the Census Bureau, and the number of young people without coverage is growing especially fast - those ages 18 to 34 increased by 800,000 in the last year to a total of more than 16 million.
Many, because they are single and without children, take a chance on not getting seriously ill or injured, a decision some experts say isn't totally foolish.
"It's not a bad bet," said Len Nichols, an economist at the Center for Studying Health System Change in Washington, D.C.
"For healthy 20- and 30-year-olds, the immortals, the bet makes sense to them," he said. "But if they do get the worst-case scenario, like cancer, they aren't covered, and taxpayers end up covering their bets."
Ron Pollack, executive director of Families USA, a health care consumer advocacy group, said for most people, there's no choice but to go without insurance.
"Unemployment compensation compared to health care costs is nowhere near enough to pay for coverage," Pollack said.
Szamody admits he worries about getting sick or hurt - but not enough to forgo a snowboarding trip to Winter Park, Colo. And he doesn't plan to get insurance until he finds a new job that covers him.
"I just see it as a waste of money," he said. "I think, that'll never happen to me, that bad stuff happens to other people. Of course, I never thought I would get laid off either."
Melissa Hunter, 28, was laid off from a New York public relations firm in 2000, and chose to go without health insurance and birth control pills for almost a year.
"It was always on my mind," Hunter said. "I wanted to be responsible and take care of my body."
Hunter eventually got a new job and a new health insurance plan. "The first appointment I made was with my gynecologist for a new birth control prescription," she said.
There aren't enough affordable insurance alternatives for the newly unemployed, according to Diane Rowland, vice president of the Kaiser Commission on Medicaid and the Uninsured, a nonprofit health care policy group based in Washington, D.C.
Employees, accustomed to sharing the cost with their employer, "are stunned and shocked by the sticker price," said Rowland.
Most laid-off workers are given the single option of remaining on their employer-sponsored health care plan through COBRA, which stands for the Consolidated Omnibus Budget Reconciliation Act of 1986. The average cost is $3,000 a year for individuals, and $8,000 a year for a family.
Only one out of five eligible people chooses COBRA, usually because they have a pre-existing condition that requires them to maintain coverage. The rest just don't have insurance, although they do have other options, including private short-term coverage.
"People go without insurance for a combination of reasons," says Rob Guilbert, a spokesman for Fortis Health Care, the nation's largest short-term health insurance provider. "Because of cost, priorities, and because a lot of time they aren't aware it exists."
Fortis offers insurance in 46 states, including short-term plans for as low as $50 a month in some. The company is targeting the young uninsured.
The Bush administration has proposed tax credits for an estimated 25 million people who cannot get employer-sponsored or public insurance, a move that could especially help young, healthy people for whom premiums are not that high.
"Under the Bush proposal, the tax credit could pick up half or more of your premium," said Kerry Smith, director of government relations at Fortis. "You offer somebody $3,000 a year and they are not going to walk away. "
Karen Ignagni, vice president of the American Association of Health Plans, agrees. "Research shows that people will buy insurance with help."
But, she said, politicians must also look at current laws and regulations that prevent states from offering affordable products and packages to these individuals. Ignagni said there are about 10 million workers who could get insurance through their employers but still cannot afford to pay their share of the arrangement.
When Bryce Schroer-Shepord, 25, of Rye, N.Y., was laid off from her job at Oxygen Media, she looked into her options. She researched private insurers, and glanced at COBRA coverage, but neither were affordable on her $297 weekly unemployment check.
"I had to prioritize," Shepord said. She didn't want to give up her cell phone or going out with friends to bars. "Finally, it came down to my car payment or health insurance. I chose my car."
It was not an easy decision. Shepord is asthmatic. Her prescription for Singulair, a popular asthma medication, is over $100 a month. Each doctor visit is $90. Most months she paid the cost directly because it was cheaper than a comprehensive health plan. When money was tight she borrowed similar medication from relatives.
Shepord spent almost a year unemployed and uninsured before getting hired as an advertising assistant at ITN Networks. The new job has an insurance plan - "a good one," she says, but coverage does not start for 90 days.
"I have a list of doctors all lined up, and a pile of prescriptions to fill," she said.
By Alex Polier