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Tchernavia Montgomery, executive director of Charlotte-based Care Ring, said North Carolina lawmakers’ hesitancy to expand Medicaid eligibility combined with lack of access to private health insurance through the federal marketplace makes it more difficult for young adults to get coverage.

When Tash Qawwee aged out of her mother’s health insurance at age 22, she started worrying about what a serious illness would do to her financial health.

“I try to do my best to stay out of harm’s way and if anything happens, I try to treat it to the best of my abilities and knowledge,” said Qawwee, 25.

Though Qawwee is enrolled in a Medicaid family plan, the only thing she can get covered is checkups. As an independent contractor who is ineligible for a company plan, her health care must be paid out of pocket, and obtaining private insurance results in a further financial burden.

“I don’t have private insurance because I don’t have a full-time job to be able to pay for insurance or have it covered for me,” she said. “The anxiety of getting into a situation that would require medical attention is the scariest part.”

Like Qawwee, most people lacking adequate health insurance in Mecklenburg County are young. About 50% of young adults in the county between the ages of 18-29 don’t have health coverage according to a survey taken by the health department.

“Access to primary care continues to be one of the leading health concerns for Mecklenburg County residents,” said Dr. Raynard Washington, director of Mecklenburg County Public Health.  “This report provides a snapshot of the current landscape, offers some recommendations for all community stakeholders, and of course, the data to inform the decisions and progress going forward.”

This population remains the highest rate of uninsured out of any age group according to the Centers for Medicare and Medicaid Services.

In the 2019 American Community Survey, adults aged 19 to 34 made up 30% of uninsured Americans. About 11% of Mecklenburg County residents don’t have coverage, with 23% of residents reported not having a primary care provider, according to the 2021 Mecklenburg County Behavioral Risk Factor Surveillance System survey.

When people go without health care, acute conditions that could be managed with regular screening can become more severe, resulting in complex care and more money spent at the doctor’s office.

“We have not expanded Medicaid in our state, so it may be more difficult for them to receive public coverage,” said Tchernavia Montgomery, executive director of the nonprofit Care Ring in Charlotte. “They would need to transition to a private plan. It is difficult sometimes to make that transition or to be able to absorb that cost.”

Many go without health coverage once they are kicked off their parents’ health insurance after age 26, when under the Affordable Care Act, they are no longer considered dependents. Once they turn 27, they are on their own for federal marketplace insurance unless they get a job with health benefits.

“It means that you could go to college and into the work world and have insurance while you’re looking for work or whether you’re in between jobs,” Montgomery said.

Prior to the ACA, many health plans and insurers removed young people off their parents’ policies because of their age, which left many college graduates without coverage.

Younger people have less access to employer-based insurance with them typically starting off working entry-level and part-time jobs, or for small businesses that don’t offer health coverage.

The chances of obtaining private insurance during the gap is a possibility, but for people between jobs, it’s a luxury many can’t afford or even think about.

“I have been without coverage for so long that I have not even thought about getting into private insurance,” said 25-year-old JarQuez Anderson, who has been without health insurance since Oct. 2020. “My biggest fear is getting hurt and not being able to work and provide for my family.”

When Anderson aged out of his parents’ healthcare, he began looking for work that could take care of those issues but was unsuccessful. Like many, Anderson believes healthcare insurance should be provided by employers.

“I feel like it is [not offered] because they are cheap,” he said. “The state needs to look more at the companies that are not offering benefits, because if you are working, I feel like the company should always provide that.”

A common belief among many young people is that they are in perfect health and can live without health insurance. One in six young adults have chronic conditions like cancer, asthma, or diabetes, according to CMS. The high cost of care makes it harder for them to afford coverage, with nearly half of uninsured young Americans reporting difficulty paying medical bills.

North Carolina has not expanded Medicaid coverage but if the state did Medicaid expansion, it would provide coverage for an additional 64,281 Mecklenburg County residents and 600,000 people across the state. As of October, there are over 2 million North Carolinians covered under the public insurance program. In 2022, the federal government offered the state $5.9 billion for Medicaid Expansion, but the Republican-leaning General Assembly said no.

Lawmakers could not come to a mutual agreement about the logistics and are expected to revisit the topic in 2023.

Aaliyah Bowden, a Report For America corps member, covers health for The Post. Mayra Parrilla Guerrero is a correspondent.