When Jenna Zies moved to Sacramento, she took a few temporary jobs, then found work as a substitute teacher. The job didn't come with health insurance, and she figured she could go without coverage for a while.
"I looked into [insurance] but thought it was just too expensive for me to afford," said the 27-year-old, who was spending most of her money on rent, transportation and school loans. "I was 25. I didn't think I would have a health crisis."
She was wrong -- as are many Americans who count on remaining healthy while they don't have medical insurance.
One afternoon in December 2001, Zies was talking to a student when her words came out in an incomprehensible garble, "like a backward tape recorder." Then, she said, her left arm went numb.
After two days of trying to cope with the symptoms on her own, she drove herself to the hospital emergency room, "not thinking about the costs because I was so scared." The preliminary diagnosis: a mild stroke. Her trip to the emergency room left her with a $3,000 bill.
Zies was among an estimated 54.8 million working Americans who were without insurance for at least three months during 2002 and 2003, according to a recent study by Families USA, a Washington, D.C.-based health policy advocacy group that supports healthcare reform.
Although this is a diverse group of working Americans, many are finding themselves wrestling with the same question: How important a priority is health insurance among all of life's expenses?
For many, the consequences of going without health insurance don't seem as immediate as cutting back on grocery bills, going without car insurance, or missing a rent or mortgage payment. So they decide to take a chance -- a calculated risk that they won't face a serious and costly health crisis -- and forego health coverage for months or years at a time.
The most likely group to take that chance are young -- and relatively healthy -- adults ages 18 to 24, according to the Families USA survey. The second most likely group to forgo insurance is people ages 25 to 44.
"In terms of figuring bills out, young people feel like they're less likely to be sick. They have a tougher time getting coverage in the workplace and paying for it on their own," said Ron Pollock, executive director of Families USA.
The statistics run counter to the image still held by some Americans that the uninsured are mostly poor, nonworking people. Indeed, it is estimated that more than 80% of the nation's uninsured are employed.
"There's no question that this problem is reaching deeper into the middle class and working families," Pollock said.
In California, one out of five people under age 65 is uninsured at some point during a typical year, said Richard Brown, director of the UCLA Center for Health Policy Research. In fact, most Californians probably have a family member, friend or co-worker who lacks health insurance, though they may not always be aware of it. "You may not know it if they haven't talked about it or if something catastrophic hasn't happened," Brown said.
With the cost of health insurance and prescription drugs on the rise, employers are shifting more of the cost to workers while scaling back benefits -- or, in the case of many small businesses, eliminating coverage altogether. As a result, many workers -- nannies and substitute teachers, artists and skilled laborers -- are finding themselves in hospital emergency rooms without health insurance.
Which is where Zies found herself.
The emergency room doctors told Zies she had most likely suffered a mild stroke. She needed to see a specialist, they said, and undergo more tests. "I knew I couldn't afford those tests," Zies said.
When the bill came, she realized she'd have to get insurance. However, Zies had difficulty finding insurance because of her health situation. After two months of looking, she found a plan and received the MRI and the treatment she needed.
Eric Moore, 33, of Los Angeles has a similar tale. In 2002, Moore, a recent UCLA graduate, was earning $7 to $10 an hour working as a Web page designer. His part-time jobs didn't offer health benefits, and a private insurance policy would have cost him about $125 a month, which he thought he couldn't afford.
"I just didn't think," he said. "I thought I'd be OK."
Then, one day, Moore developed pain in his leg. Because he lacked insurance, he didn't see a doctor right away. A month later, he was in the emergency room with a massive blood clot in his leg.
In hindsight, the insurance would have been a bargain compared with the $14,000 bill he faced after a four-day hospital stay to treat a pulmonary embolism. Unable to find full-time work, Moore has moved back in with his mother, who gave him $2,000 to help with the bill. He is slowly paying off the remaining $12,000 with income from temporary jobs.
For the 5 million working Californians without health insurance, the options for finding affordable coverage are scarce. Those without chronic medical conditions that might result in an insurer denying them coverage can opt for what's known as "catastrophic" insurance plans, which cost a few hundred dollars a month, don't cover routine doctor visits or prescriptions, but do cover things like stays in a hospital's intensive care unit.
Several Internet-based companies, such as eHealthinsurance.com and Insure.com, allow people and small businesses to compare prices for a range of plans from different carriers. Most insurance companies also offer short-term insurance (usually for a minimum of six months), which people can price for themselves on their Internet sites. A site operated by Georgetown University's Health Policy Institute at www.healthinsuranceinfo.net has information for all 50 states on the types of insurance and what to do in case of serious illness.
This is "something that touches so many people and affects them at one time or another," said UCLA's Brown, whose daughter, a self-employed artist, went without health insurance for several years until she injured her back. She finally managed to get coverage shortly before her herniated disc ruptured and she went in for surgery -- an event that would have put her in severe debt without insurance.