By: Emily Beaver

Congress is about to make a big decision: whether or not to pass health care reform. Democrats are optimistic they'll be able pass a health reform bill by Sunday. But when it comes to a controversial political issue like health care reform, the outcome still isn't certain.

To get some perspective, Youth Radio talked to health care and health insurance experts and health care reform advocates about what the future would look like for young people if reform passes -- or if reform doesn't pass.

A future without reform

Millions of Americans (an estimated 49.4 million, to be precise) don't have health insurance. And the number of uninsured Americans will keep growing -- people who get health insurance at work will lose their coverage, because as health care costs increase it becomes harder for employers to provide insurance coverage. Workers who do keep their insurance will pay more out of their own pockets.

That's how Melissa Rodgers, associate director of the Berkeley Center on Health, Economic, and Family Security, describes what could happen if health reform doesn't pass.

And a future without health care reform may not look brighter for people who purchase their own health care. Insurance companies have raised premiums for some people who buy insurance from the individual market, and there's no reason to expect that the trend of increasing health care costs won't continue, Rodgers says.

Rising health care costs are one of the reasons our country is trying to reform health care, says Sam Gibbs, senior vice president, of eHealthInsurance, a company that allows people to search for and buy health insurance plans online. Without reform, Americans will be spending more of the money we make on health care in the future, Gibbs says.

"If health reform doesn't pass, we will still have a broken system where young people are still the most uninsured group," says Heather Smith, president of Rock the Vote, a youth political advocacy organization.

After the jump: an alternative future...

If health reform happens

Health care reform would bring dramatic changes for many Americans, especially young adults. About 13 million young adults ages 19-29 are uninsured. Many uninsured young Americans would be eligible for Medicaid, the government insurance program for low-income and poor people, Rodgers says.

Other uninsured young adults who don't get insurance through Medicaid have a few other options. they can stay on their parents' insurance plans until age 26, buy an insurance plan through a government health insurance exchange (and many young adults will get subsidies from the government to do this) or buy their own insurance from the individual market.

Young adults who buy their own insurance could see their rates increase after health reform. That's because health reform puts limits on a health insurance industry practice called age rating, charging younger people less for insurance than older people. Health reform legislation will limit how much more insurers can charge older people for insurance, says Gibbs, so while older people's rates may go down, younger people's rates could go up.

However, health care reform will allow people who like their current health insurance to keep their plan, so now is good time for young people who buy their own insurance to find a plan they like, Gibbs says.

Health care reform will also make it easier for young adults who have pre-existing health conditions, like asthma or diabetes, to get insurance or to change insurance plans.

If reform passes, the stereotype of the "Young Invincible," the young, healthy adult who chooses to skip health insurance would also go away -- that's because all Americans would have to get insurance, unless they can prove a hardship that prevents them from getting insured, or pay a penalty.

If health care reform happens, Aaron Smith, a Georgetown University law student, thinks young people will have to undergo a "cultural shift" where getting health insurance is a normal expectation, like buying car insurance. Aaron Smith, who is one of the founders of the Young Invincibles, a group of young adults who support health reform, was uninsured for about six months after he graduated from college. Young people won't have those gaps in coverage any more, he says.

"Think about the millions of young adults without healthcare," he says. "They won't have to worry about health care bankrupting them if they get sick."

An added bonus of health care reform passing? Democrats in Congress want to pass it along with a bill to help students get lower-cost loans for college, through a legislative process called budget reconciliation.