Students Missing in Health Plans

WASHINGTON – The Senate Finance Committee approved its bill Tuesday to overhaul the American health care system, pushing Democrats’ reform efforts closer to reality, but still leaving plenty of ambiguity in the plan to be worked out by Congress and the White House.

One issue still unresolved is what, if any, provisions the final legislation (which, it’s widely agreed, will end up looking a lot like the Finance Committee’s bill) will make for college students and campus-based health plans. As it exists after clearing committee, the Senate bill seems, perhaps inadvertently, to leave no room for college-provided student insurance plans.

“Congress simply isn’t thinking about college students’ health care,” said Jim Turner, president of the American College Health Association. “They’re not trying to be malicious, I don’t think, but the legislation could unintentionally be eliminating student health insurance programs.”

The Finance Committee’s bill classifies plans under two categories: employer-based group plans and individual policies purchased through an insurance exchange. College-issued plans are neither. Instead, they’re classified by an exemption to Health Insurance Portability and Accountability Act of 1996 (HIPAA) which, Turner said, defines them as “limited duration products.”

Last week, Turner and Doyle Randol, ACHA’s executive director, wrote to Sen. Max Baucus (D-Mont.), chairman of the Finance Committee, asking for clarification “that nothing in the proposed legislation is intended to, nor will inhibit or preclude the continuance of college sponsored (or college self-insured) student health insurance plans and that colleges will retain the ability to mandate comprehensive coverage levels for their students.”

Jim Mitchell, director of Student Health Services at Montana State University and spokesperson for the Lookout Mountain Group, which advocates for student health care, said his organization is also concerned that there's “no room for student insurance to exist” under the committee’s bill. He expressed a sentiment similar to Turner’s, saying that the omission of student health plans “is an unintentional consequence as they’re trying to craft a very complex bill.” Now, like Turner, he simply wants Congress “to craft language that will keep student plans going.”

Student insurance plans were offered at 71 percent of four-year private non-profit colleges, 82 percent of four-year publics and 29 percent of two-year publics during the 2007-08 academic year, the Government Accountability Office reported in March 2008.

In 2006, the same analysis found, 67 percent of college students aged 18 to 23 received insurance through employer-sponsored plans (most likely their parents’), while 6 percent were covered by public insurance plans like Medicaid. Another 7 percent had coverage through non-employer private plans, including student insurance programs. The remaining 20 percent were uninsured.

Jim Boyle, president of College Parents for America, said the priority should be to ensure that private employer-based plans be accepted at campus health centers since there are, perhaps, 10 college students covered by those plans for every one covered by a student plan.

“Many colleges are beginning to require that students buy their health plans, or are at least not accepting any other private insurance at their campus health centers,” he said. “They’re asking these students and their families to pay twice for coverage just to ensure that the student will be able to be treated on campus rather than having to go to the emergency room of the hospital down the road. It’s an issue that sits under the umbrella of college costs, which everyone’s concerned about.”

Another point of concern in the Finance Committee’s bill is the creation of “young invincible” policies, catastrophic-only policies available to people under 25 for less than the cost of a comprehensive plan, which are aimed at young people who think they're healthy enough not to need insurance,

Mitchell, of Lookout Mountain Group, said young invincible plans “wouldn’t really give students the support they need … they’re low-quality but would probably cost about the same as more comprehensive student health plans.”

The plans wouldn’t cover prescription drug costs, care for chronic illnesses or emergency room visits, all common health care needs for college students generally included in student health plans. Based on his research, the plans would likely cost between $1,200 and $1,500 annually, while many student insurance plans cost between $1,500 and $1,800. “For a little bit more money with a campus plan, you’d be getting a lot more.”

Ari Matusiak, a co-founder of Young Invincibles, a health reform group advocating for 18 to 34 year-olds, said such plans would be “insurance they can afford but insurance in name only,” and wouldn't give students the coverage they need. “There cannot be a distinction between young Americans whose parents have insurance and those who don’t and have to turn to these lower-quality plans just to have anything at all.” His group would like to see more comprehensive, low-cost plans available for students and recent graduates who can’t get coverage elsewhere.

But for students whose parents are insured, coverage under those plans would make the most sense, Matusiak said just hours after speaking at a Tuesday press conference at which Speaker of the House Nancy Pelosi (D-Calif.) announced the House bill will allow young people to stay covered under their parents’ plans until age 27. Current age limits vary state-by-state, but most are several years lower than 27. “If there’s any provision that matters most to college students, it’s that one,” he said. “Most college students are covered by their parents’ plans and want to be covered under those plans since they come with little or no cost to them.”

Because of the current state of the job market, he added, “as college students are getting their diplomas, one thing that is becoming increasingly clear is … they may experience a time of uninsurance because they’re between school and whatever comes next.” The ability to stay on a parent’s plan gives them an easy source of coverage.

Boyle, of College Parents of America, applauded that movement, too. “I think President Obama wants to see parental coverage extended up through the late 20s and I think that makes a lot of sense,” he said.

ACHA’s Turner said his group supports provisions to help students stay on their parents’ plans. But, he added, “I’ve heard anecdotes that students are losing their health insurance because parents are losing their jobs. If a school can continue to offer a comprehensive insurance plan that is reasonably priced, that is critical to covering students who are otherwise losing their coverage.”