Crisis on Campus: Student Access to Health Care

Abstract

College-aged adults are an overrepresented group in the uninsured population of the United States, and traditionally underserved minorities are disproportionately affected. Students with private health insurance are often functionally uninsured as well, since most schools refuse to accept this traditionally elite calling card on campus. Consequently, the large uninsured and functionally uninsured populations often rely on school-sponsored health insurance plans for access to care. These plans have uneven coverage, limited benefits, exclusions and high co-pays and deductibles, and provide little health care security for their beneficiaries. Further, schools and insurance companies have profited substantially from these student plans, raising the possibility of a conflict of interest, with school-sponsored plans that may be focused on financial benefits to schools rather than the health of students. In addition, these plans may violate public policy and consumer protection laws by charging those who do not enroll in school-sponsored plans higher prices and by disingenuously claiming "competitive" rates when advertising to students. Public efforts at a student mandate, such as in Massachusetts, although successful in increasing the number of students with health insurance, have failed to provide adequate access to care. A focused policy must be put into place to ensure that students can effectively and efficiently access needed health care services on campus. In support of this effort, a proposed statute is provided herein. This bill would amend the Higher Education Opportunity Act to create a student health insurance mandate. School-sponsored plans, as well as private plans with comparable coverage, would be required to fulfill a minimum standard benefits plan. Reasonable exclusions and limitations would be allowed, based on standard practices in commercial health insurance plans. The statute would require a minimum percentage of premiums to be spent on health care, with any excess rebated to students. It would also require schools to accept a student's private health insurance for campus services to avoid forcing students to pay more than once for care. As part of this mandate, a portion of the surplus retained by schools billing private insurers would be allocated to create health insurance scholarships for uninsured students. Finally, the definition of "cost of attendance" would be adjusted to ensure that financial aid calculations take into account health insurance premiums.