Among the Uninsured: 1.7 Million College Students

About 1.7 million traditional-aged college students, or 20 percent, are uninsured in the United States. And student health plans – offered by 57 percent of all colleges – vary dramatically in terms of services covered, according to a new report on college students and health insurance released by the United States Government Accountability Office Friday.

In a review of student health coverage available at 340 randomly selected colleges, the GAO found that annual student health plan premiums range in cost from $30 to $2,400, with some plans excluding or limiting preventative care, prescription drug coverage and other health services. Maximum benefit amounts vary from $2,500 per condition, per year (which won’t cover the cost of a hospital stay of any consequence), to $1 million per lifetime.

“This is probably the most comprehensive review of the field that anyone has ever done,” said Dana Mills, chair of the American College Health Association’s Student Health Insurance Task Force and director of student health service at Marquette University. “I think one of the take-home points is they did review actual student health insurance plans across the country and we saw a big variation in costs and benefits and features of the plans. For each of us on our campuses, we need to look and see what kind of value are we getting out of our student health insurance plan? Is it something that is meeting the need? Are we only concerned about the costs and not opening it up and seeing what the benefits are?”

“I haven’t seen that $30 plan," Mills said, "but I think you get what you pay for.”

The new report finds that the majority of college students aged 18-23 receive their health insurance through another person’s policy, such as by being dependents on parents’ policies. In 2006, 67 percent of students received health insurance through employer-sponsored plans, which cover employees and their dependents; 7 percent through other private insurance plans, including student insurance plans offered by colleges, and 6 percent through public programs like Medicaid.

Meanwhile, the 1.7 million uninsured racked up from $120 to $255 million in uncompensated, non injury-related medical care in 2005 -- with the characteristics of uninsured students consistent with those of the uninsured more generally. Groups more likely to be uninsured include part-time students, older college students (aged 22 or 23), students with lower family incomes, and Hispanic, black and Asian students. The GAO report states that students from the West and South are less likely to have insurance than students in the Northeast and Midwest.

In terms of student health plans offered by colleges, the report finds that while 57 percent of colleges offer them as an option, there are dramatic variations by sector. In the current academic year, 82 percent of four-year public institutions offer them, 71 percent of four-year private nonprofit colleges, and 29 percent of two-year publics. There are also of course the variations in coverage: “When designing their plans,” the report notes, “college administrators vary in the extent to which they prioritize premium affordability over plan benefits.” The average annual premium was around $850.

Student health plans are also often coordinated with student health center services to keep premiums down, with some colleges for instance excluding preventative services or prescription benefits from the insurance plan if they're available at the health center, the report states. In addition to varying coverage for preventative services, the report finds that plans differ in other services they might restrict – like treatment for injuries that occurred while on drugs or intoxicated, or that are the result of an attempted suicide. (The report does not go into detail relative to variations in mental health or substance abuse services covered.)

There’s also variability in the degree to which colleges extend eligibility for student health plans to part-time students -- with concern that, without restrictions on the number of credit hours needed to be eligible, students with costly medical conditions could enroll part-time only to receive health insurance, driving up premiums. (One college, in fact, apparently discovered that its student insurance plan was covering some senior citizens who registered in one-credit classes each semester.)

The GAO report also finds that only a minority – 30 percent – of colleges require that all full-time students have health insurance. Four-year private nonprofit colleges are the most likely to require it (at 62 percent), and two-year public institutions are the least (at 3 percent). (Which is not an illogical finding given that four-year private colleges are most likely to be residential and serve traditional, full-time college-aged students, while the opposite is true for community colleges.) The report highlights some strategies states and higher education governing boards have taken to increase the ranks of the insured on college campuses. Some states have expanded eligibility for dependents who remain on their parents' plans -- typically an option only available for full-time students -- upping the maximum age of eligibility, for instance, or mandating continuing coverage for students who take a leave of absence or switch to part-time status for medical reasons.

According to the report, Massachusetts and New Jersey have laws in place requiring that college students have health insurance (though part-timers are largely exempted). The University of California and the Idaho State Board of Education also have system-wide health insurance requirements.

"It is unacceptable that 20 percent of college students are uninsured and that some college health plans exclude coverage for preventive services and limit payments for benefits such as prescription drugs,” Senator Edward M. Kennedy (D.-Mass.), Chairman of the Health, Education, Labor and Pensions Committee, said in a statement on the report Friday. “Students must be healthy to learn, and guaranteeing that they have quality health coverage should be a priority for our nation."

The American College Health Association recently updated its guidelines on student health insurance. Chief among them: "As a condition of enrollment, the college or university requires students to provide evidence that they have adequate health insurance coverage." Characteristics of "adequate" health insurance identified by the organization include coverage for preventative care, catastrophic illness, and prescription medications, including psychotropic drugs.

“What we think the [college-provided health care] plans should do is make health care accessible to students, and affordable,” said Mills, of the Association's task force on student insurance. “And keep them in class to the extent possible -- and make health care issues fall to the wayside and be in the background."