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Without health insurance, University of Maryland senior Susana Sagastizado gets nervous if her nose begins to run or her forehead starts to feel warm. They are all bad signs, she said, of an illness she can’t afford – literally.

Luckily, the university’s health center provides care at a reasonable price, so Sagastizado can be seen and pay for a fl u shot using income from a part-time job. But if she does get the fl u, 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 like Sagastizado have become the invisible minority in the national health care debate, as millions – middle-income and students of color especially – go without coverage. In the midst of President Barack Obama’s campaign to generate support for health care reform, 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 fi nancial issues, according to a June 2009 report by a group of college health professionals called Lookout Mountain Group.

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

Jim Mitchell, the director of student health services at Montana State University, said when he read Sen. Max Baucus’ (D-Mont.) Health care bill from the Senate Finance Committee, 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,” said Mitchell, who helped author the Lookout Mountain report. “They are a unique population and they need to be looked at as an individual group.”

In the legislative health care reform bills, there is little language addressing college students specifi cally, but the Baucus bill does include a controversial “young invincibility” policy, requiring Americans 25 and younger to purchase “catastrophic” insurance in addition to comprehensive insurance. Since young adults, ages 19 to 29, represent one of the largest uninsured groups, bringing them into the coverage risk pool could spread out costs to subsidize older Americans.

But the American College Health Association, an advocacy and leadership organization for college and university health professionals, said low premiums don’t make up for higher deductibles college students can’t afford in the bill. In a statement, ACHA asked that the provision be removed, proposing instead a co-op model for college health insurance not unlike President Obama’s plan.

While many college students have health insurance as dependents on their parents’ insurance or through a school or private insurer, the Government Accountability Offi ce estimates 20 percent of college students, or about 1.7 million people including part-time, minority and older students, lack insurance.

The GAO only measured college students between 18 and 23, while Beckley said that’s misleading since a growing number of today’s students are older than 24. 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 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. Of those, the report estimated 20 to 30 percent of students 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 underinsured, 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.

The congressional bills would require everyone to purchase insurance with minimum coverage including those basic needs.

Mitchell said he supports a national mandate for college students to have health insurance but noted 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 restrictions on coverage. In the Senate Health, Education, Labor and Pensions (HELP) Committee’s bill, young people could remain dependents up to age 26 on their parents’ insurance policies.

College students of color have a higher propensity to be uninsured so coverage can be more of a luxury than a necessity since many can’t afford it. Nationally, minorities are disproportionately represented among the uninsured for young adults between the ages of 19 and 29, according to The Commonwealth Fund, a private organization providing independent health care research.

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