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College Students are Health Care’s Invisible Minority

Close to 5 million students don’t have health insurance, report says.

Susana Sagastizado, a senior at the University of Maryland, started coughing today. Her nose is running a bit and she feels an ill warmth on her forehead — all bad signs, she said since she doesn’t have health insurance.

Luckily, the university’s health center provides care at a reasonable price, so Sagastizado can be seen and pay for a flu shot using her part-time income. But if she does have the flu, joining the more than 600 suspected cases at Maryland, it gets worse. The 21-year-old’s good fortune could end.

“I worry about it a lot, it’s always in the back of my head,” Sagastizado said about not having insurance. Her parents can’t afford to have her and her two brothers on their insurance without losing their home. “I feel anxious especially when I’m sick. You always think of the worst-case scenario that you might have to go to an emergency room.”

College students have become the invisible minority in the national health care debate, as millions—middle-income and students of color especially— go without coverage. On the heels of President Barack Obama’s health care speech to students at Maryland, experts interviewed by Diverse say college students are being left out.

Though often considered the most vibrant and healthy class of privileged Americans, postsecondary students have serious short and long-term health and financial issues, according to a June 2009 report by a group of college health professionals.

“College students have a higher propensity to be uninsured for longer than other young adults,” said Stephen Beckley, a student health insurance consultant for more than 200 schools including Dartmouth College and Duke University. “They use an impressive amount of health care, not unlike other groups.”

Beckley is one of the researchers in the Lookout Mountain Group (LMG) report released by an unaffiliated, nonpartisan, grass-roots coalition of college health professionals.

Jim Mitchell, the director of the student health services at Montana State University, said when he read Sen. Max Baucus’ (D-Mont.) health care bill from the Senate Finance Committee Wednesday, he was disappointed.

“They are assuming college students and young adults are the same and they think the solutions they are coming up with for people under 30 will also work for college students,” Mitchell said, who helped author that report and has contributed to the American College Health Association. “They are a unique population and they need to be looked at as an individual group.”

While in college, many students have health insurance as dependents on their parent’s insurance or through a school or private insurer, but many students are falling into a widening chasm in the coverage pool.

Chances are part-time students, minorities, older adults or students at two-year institutions fall among the 20 percent or more than 1.7 million without coverage, according to estimates from a 2008 report to the Senate from the Government Accountability Office.

But Beckley considers the government’s findings misleading because they use a national sample that masks the reality of the uninsured and under-insured in individual states.

The GAO only measured college students between 18 and 23, while Beckley said a growing number of today’s students are older than 24, going to school later after working full-time or the military for example. The number of uninsured college students, he said, is somewhere between 4 million and 5 million.

In its annual almanac, The Chronicle of Higher Education said since 1980, college students have been getting older and they now consist of 40 percent of all students.

The GAO also found that 22 percent of public four-year universities and colleges and 62 percent of private four-year institutions require health insurance as a condition for enrollment for full-time students.

The LMG report estimated that among the insured, between 20 to 30 percent are under-insured or lack adequate coverage.

“Some school-sponsored plans are so nominal in scope of coverage that it’s like not having coverage,” Beckley said. “The populations they are covering are under-insured and the plans are far from complying with ACHA standards of good insurance.”

Some plans even exclude coverage for pregnancy and mental health conditions, and provide poor prescription drug coverage for students who may have chronic conditions, the report said. College students tend to be active, Mitchell said, and most often report accidental injuries.

“Let’s say they get a concussion playing sports and end up in the emergency room getting a CAT scan, an MRI, or more,” he said. “That can go as far as $3,000 to $5,000 in medical bills.”

The ACHA, an advocacy and leadership organization for college and university health, has set standards for health insurance and care for its more than 900 member schools and 3,000 college health care professionals since 1920.

Mitchell, who has contributed to research for the organization, said both he and ACHA support a national mandate for college students to have health insurance but there is no accountability measure in place to make sure health insurance limits are reasonable and affordable.

Even for students on dependent employer-sponsored plans, cost shifting and changes in eligibility requirements place severe coverage restrictions.

College students of color have a higher propensity to be uninsured so coverage can be more a luxury than a necessity since many can’t afford it. Disruptions in access make these individuals like Sagastizado vulnerable to high costs and high health risks particularly during flu season.

Sagastizado isn’t a typical student. She takes 15 credit hours and works 16 hours a week to help her immigrant parents pay bills. She recently applied for Medicaid, but the history and criminal justice major doesn’t think she will be accepted for coverage.

Beckley said his studies have shown that students who are uninsured are twice as likely to have trouble accessing health care later in life preventing them from receiving preventive care for chronic conditions.

Nationally, minorities are disproportionately represented among the uninsured for young adults between the ages of 19 to 29, according to The Commonwealth Fund, a private organization providing independent health care research.

“There is an existing health system designed for students with nurses, doctors, pharmacies etc on college campuses,” Mitchell said, “So the kind of insurance they need needs has to wrap around that system, cover hospitalization cost, and any other catastrophic health issues.”

Recent Graduates Fall Short on Coverage

With college graduates coming into one of the worst job markets in a 25 years, according to the U.S. Department of Labor — 15 percent of 20-24 year olds were unemployed in June — the young, dropped and jobless make up at least 30 percent of the uninsured nationwide.

The Wall Street Journal reported that recession-era graduates can expect to earn less in wages, trading low-skilled jobs for their dream careers and limiting their health care access.

The Fund’s 2009 report noted a breakdown in health coverage once a student earns a college degree. A few insurance plans will cover students until their 22nd birthday and some have extended that grace period for recent graduates.

 “This is a time when we want them [young adults] to establish connections to the health care system,” said Sara Collins, vice president of the Fund’s Affordable Health Insurance Program. Lower incomes will only exacerbate concerns for the fastest-growing segments of the U.S. population without health insurance.

–Arelis Hernandez

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