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Two full months before she recently turned 50, Deborah Sibony, an artist and graphic designer who lives in Berkeley, Calif., received a frosty birthday greeting from her health insurance provider. The cost for her coverage would be going up $100 a month the company told her—simply because she was gaining a year.

“It made me feel crummy,” said Sibony, who like many Americans once received health insurance through her workplace but now, working as an independent contractor, must fend for herself. “It makes me feel like they don’t care about the fact that I’m in good health and don’t get sick. There’s no discount for taking care of yourself.”

Meanwhile, Sibony’s stepson Walker Koppelman-Brown, 26—who lives in the family home, is healthy and has a job—can’t afford the $400 he’d have to pay for his own individual health insurance, even though it is less than half of what his stepmother pays for herself, her husband and two young children.

So, for the moment, he goes without.

As Congress wrestles with a mammoth health care overhaul that it hopes will cover an estimated 46 million Americans who are currently uninsured, one sticking point has emerged—how much more health insurers should be allowed to charge those between 50 and 64, who are not yet eligible for Medicare. In short, Congress wants to find ways to ensure that both Sibony and Koppelman-Brown can afford health insurance, without bankrupting the government.

In some markets today, older adults like Sibony can pay seven times what younger workers do for comparable insurance, based solely on their age. The emerging battle over “age rating,” the practice of using age as a basis for computing health insurance premiums, has the potential to unleash festering generational conflict, experts warn. Most of the proposals before Congress would effectively raise costs for younger Americans like Koppelman-Brown to help subsidize the health care costs for his step-mom. About 7.5 million Americans ages 50 to 64—or 13 percent—were uninsured in 2008, a figure that is growing rapidly, according to AARP.

Charging extra for age

Under the House health reform proposal, that ratio would be capped at 2 to 1—so insurance companies could charge no more than twice what they charge for younger adults. One measure now making its way through the Senate would limit the ratio to 4 to 1—allowing them to charge older Americans four times more than younger ones—a figure more acceptable to the insurance industry because it would allow them to offer more attractive rates to younger workers.

“My clients who are younger are very happy they are not paying to subsidize older clients,” says Joel Rosenblum, an independent health insurance broker based in Boulder, Colo. “My older clients are never happy when they see the higher premium increases. It’s two sides of the same coin, and whatever you do there will be substantial winners and loser.”

Everyone agrees on one basic point: As people grow older, their health care needs tend to increase. A typical person between age 18 and 24 incurs $1,441 in annual health care expenses, according to research by the Kaiser Family Foundation. The annual tally for someone between 45 and 64 is more than three times that: $4,863.

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