ALBANY, N.Y. As health care reform works its way through Congress, people like Pat McGowin, of Troy, N.Y., and Sally Block, of Albany, are tuned to its progress. They are among the more than 18 million young adults without health insurance in America, according to the California-based Kaiser Family Foundations Commission on Medicaid and the Uninsured.

Two years after a brush with bad leafy greens, McGowin, 25, was still paying the hospital bill for his case of food poisoning. He worked out a payment plan to cover the $600 bill, which allowed him to remit about $40 each month, including interest, until the bill was paid.

Other than the food poisoning and an aggressive snowboarding stunt that resulted in a back injury so horrific McGowin couldnt stand for several days, hes been healthy.

As a result, McGowin hasnt made health insurance a priority. Instead of paying for private insurance, he goes to the doctor only when he cant bear it anymore. Then, and only then, hell head over to an urgent care center.

At that point Ill pay any amount of money to get rid of whats bothering me, says McGowin, who handles production and promotion as the assistant manager of Revolution Hall in Troy. The company has only six full-time employees, too few to make a group health insurance plan financially feasible.

McGowin has passed on federal or state-subsidized insurance plans, such as Healthy New York, reasoning hes relatively healthy and doesnt want to add another cost to his monthly student loan, rent and car payments. McGowin is hoping federal health care reform will make health coverage less expensive.

Block doesnt qualify for Healthy New York. The 26-year-old college graduate has been uninsured since losing her full-time job as a customer service representative for Lexis Nexis two years ago. She remains jobless despite applying for dozens of positions and works temporary jobs until she finds something permanent. For now, she is on welfare.

Block calls herself pretty healthy and visits the doctor about once a year. She goes to Planned Parenthood to receive her annual OB/GYN appointment for free. The group offers reduced or no-cost care to women under its Family Planning Benefits Program.

What isnt free are migraine and depression medications prescriptions she needs to function. Blocks dad helps her pay her $200-a-month prescription bill, but shes also taken to gambling with her medications. She says she can skip two to three days of her headache or depression drugs without serious complications.

Any more than that, though, and Block ends up stuck in the house, blinds drawn, wishing she were like her friends who are employed and insured. She has applied for Medicaid, which would cover most of her medical costs, and is waiting for approval.

Although it is true that, on average, younger adults have fewer health care needs than older adults, there are still important reasons for people within the age group to obtain health insurance, says Cori Uccello, a senior health fellow at The American Academy of Actuaries, based in Washington, D.C. She points to a survey the not-for-profit did on health care costs. The average 18-to-24-year-old spends about $1,440 a year on medical bills, including prescriptions. A 25-to-34-year-old spends around $2,100 annually.

The figures include all individuals, regardless of insurance status (so those with low, or no, deductibles or copays are included), meaning many people pay much more.

Insurance can protect against the financial costs associated with unexpected and catastrophic health care needs, Uccello says. Even seemingly healthy people can become ill or have an accident that requires expensive health care services.

Bills that can result if you do fall ill or are injured can be financially crushing, says Steven Bouchey, a financial planner for Bouchey Financial Group in Troy, especially if you are unemployed or working at an entry-level, minimum-wage job. Like any financial planner, Bouchey considers debt one of the dirty, four-letter words. But, he points out, if the decision is between your health, and carrying a balance on a credit card because of health insurance costs, the latter is worth it.

Your health is more important than money, says Bouchey. Forget about how much money you have. If you dont have your health, you have nothing.

When people are deciding between having health insurance and risking going without it, he says, he always advises them to go with the health plan, since you cannot plan or predict when you may get sick.

But what about people who say they cant afford insurance? Bouchey suggests they look into a high-deductible plan.

High-deductible plans work just as they do for car insurance. The monthly payment is minimal, but the deductible at the doctors office, hospital or pharmacy is higher than with a standard plan. If a person is young, healthy and does not rely on maintenance drugs for diseases such as high cholesterol or blood pressure, diabetes or mental health, then the coverage is fine.

Someday, though, you may not be fine. As Bouchey says, the most debilitating illnesses or injuries often arrive without warning.

But many recent college graduates, often referred to as young invincibles because many believe they cant get sick, dont feel thats enough motivation for them to pay several hundred dollars a month for health insurance.

In the meantime, McGowin, Block and millions of Americans will continue to gamble with their health, weighing the options between paying now for protection they may not need or, perhaps, ending up like McGowin and paying for one bad meal for years.