Paying for Campus Health Care

SAN FRANCISCO — It’s not just Congress and the Obama administration that are pondering how to pay for health care. As the American College Health Association’s annual meeting got underway here Wednesday, officials from Wisconsin private colleges reported on significant health and financial gains they have achieved by requiring all full-time undergraduates not only to have health insurance, but to participate in a common plan financed by a small part of their tuition dollars.

While only about 30 percent of colleges require students to use a specific insurance policy, the session attracted a full house and engaged questions, suggesting interest at other institutions (as well as some apprehension).

But according to the college officials who explained how the program is working in Wisconsin, its costs are minimal and the improvements in health care (and possibly student retention) are significant.

Nationally, about 20 percent of traditional-age undergraduates have no health insurance, and some additional percentage lack adequate insurance. The figures for the uninsured are much higher for minority students — 38 percent for Hispanic students and 29 percent for black students. While international students (who are included in the plan) must obtain health insurance for their visas, they frequently find the costs to be excessive and the coverage insufficient.

Right now may be a good time for colleges to consider whether their current systems will keep working, said Kelly McCoy, director of student services for the Wisconsin Association of Independent Colleges and Universities. She noted that about two-thirds of undergraduates are insured through their parents’ policies and that this is unfortunately a time when more parents are losing their jobs and more insurance companies are lowering the age at which students may no longer remain on their parents’ plans. The one-time norm of 25 is getting as low as 19, she said.

Cardinal Stritch University, a private institution in Wisconsin, started to notice problems more than five years ago with the lack of uniform insurance, said Sallie Horrigan, director of health services. The university of 6,000 had a health clinic that consisted of a single nurse and limited after-hours care. Faculty members reported that too many students were sick, and residence life officials said at the time that they had difficulty persuading many students to seek medical care, as they knew they had limited or no insurance. In addition, students on their parents’ policies were afraid to seek treatment for mental health issues or sexually transmitted diseases.

So Cardinal Stritch and the Wisconsin association worked together on an insurance program — about to hit year five — that has grown from just Cardinal Stritch to include 14 colleges in Wisconsin and 9 elsewhere. The program is less expensive to students and the colleges because all full-time undergraduates must participate, even if they are covered by their parents’ plans, which can become secondary plans if they want. Students enrolled part-time can also join if they want, but they must be enrolled for at least six credits, to prevent people who are not serious about being students from using the plan.

Under confidentiality agreements with the providers, the exact cost couldn’t be revealed, but the title of the session gave a maximum cost: "Insuring Students and Funding Your Student Health Center on Less Than $1 a Day." (That dollar a day simply becomes part of tuition and fees.)

With the extra funds, Cardinal Stritch has added a nurse, a medical director, a dietician and a range of new programs. In addition, Horrigan noted that prior to the new system, some local health care providers were wary of treating students, fearing that they wouldn’t get paid. "Now they want to help our students."

Under the plan, students pay nothing for services provided in the campus health center, and must seek vaccines there. Then the plan covers 80 percent in network, 60 percent out of network, a $20 co-pay for an office visit and $50 for an emergency room visit that does not lead to an admission. The plan covers office visits, surgery, hospitalization and prescription drugs. Cardinal Stritch and several other colleges in the joint plan are Roman Catholic institutions — and part of the savings bonus was contingent on all colleges offering the same services, so none of the colleges offer birth control or abortion coverage. However, McCoy of the private college association noted that all of the colleges are near state or private organizations that provide such services.

Graduates can also buy up to nine months of coverage following commencement, a feature seen as especially valuable this year, when students are having a tough time finding jobs.

Horrigan reported that in the five years the college has required participation, the campus is healthier, retention is up (from 77 to 85 percent the year the program was started, and steady since), and relations with local health providers are good. She said all the programming the college offers on health is now self-supporting.

Audience questions focused on specifics, with several questions about situations in which students with existing insurance might resist these policies. Horrigan said that problems are minimized by giving students and parents full briefings and by including costs in the single tuition bill — no one is ever writing a separate check for the insurance.

One audience member expressed fears about New York State’s attorney general, Andrew Cuomo, who has been eying college policies on student health insurance. His focus, however, has been the question of whether colleges receive payments from insurance companies they urge or require students to use, not the concept of requiring coverage. (Inside Higher Ed)

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