By Max Saltman
The global pandemic and its ensuing recession have exposed seriously ugly truths about the healthcare industry. In the past months, companies such as United Health and Anthem have doubled their profits while millions of Americans lose their health insurance. And while we like to think of Sewanee as a “bubble,” isolated from the evils of the outside world, health inequity is no stranger to the Domain. In the midst of a global pandemic, a recession, and a precarious return to campus, Sewanee still does not offer its students health insurance. That needs to change. Immediately.
Few understand this need better than Kim Bradford, the University’s student insurance coordinator.
“The silver lining of this pandemic,” Bradford said, “is that now is the prime opportunity to get the University to implement a student health insurance plan, because it’s needed now more than ever.”
When I last spoke with Bradford in January, under drastically more comfortable circumstances, she emphasized the need for a student health plan. While Sewanee offered health insurance to students in the past, the Affordable Care Act made a student health plan less essential, as students often came to Sewanee with sufficient coverage under Obamacare. So, in 2014, the University ended the program. However, as the Trump administration began flaying the ACA, the need for a student health plan returned. When I emailed her shortly before returning to campus this semester, Bradford confirmed to me that the pandemic and recession have made her “more concerned than ever” about the state of health equity at Sewanee.
Her increased concern is grounded in experience; Bradford knows firsthand the fragility in health security afflicting millions of American families. When her husband’s manufacturing job furloughed him for nine weeks earlier this year, the couple counted themselves lucky that the company continued paying their health insurance. Yet when Mr. Bradford returned to work, he received a nasty surprise on his paycheck. The $136 premium payment for health insurance that usually came out of his pay had doubled to $272. His employer was charging him twice in order to offset those nine weeks that Bradford spent furloughed. And as if this weren’t enough, Bradford worries that if her husband is furloughed again, his employer may choose not to cover the insurance at all, as they are entitled to do under the Consolidated Omnibus Budgetary Reconciliation Act, or COBRA.
With COBRA, “your employer won’t pay for your insurance while you’re furloughed, but the employee has the option to pay the full premium out of pocket,” Kim Bradford explained. “It’s very expensive.”
What makes this story frightening is that it isn’t unusual. Roughly 5.4 million Americans have lost their insurance since March. The Robert Wood Johnson Foundation estimates that if unemployment hits 20%, which it very well might, nearly 25 million Americans will lose their employer-provided insurance. If unemployment reaches 30%, that 25 million becomes 43 million. While roughly half of those who lose their insurance will be able to obtain Medicaid benefits and a quarter will seek private insurance, the rest will be left uninsured.
The statistic regarding Medicaid is crucial; only residents of states which chose to expand the program under Obamacare are able to make the switch after their job loss. Some of the states which refused to expand are among Sewanee’s biggest sources of students: Tennessee, Georgia, Alabama, Mississippi, and Texas. Bradford says that roughly one third of Sewanee students are underinsured, uninsured, or on Medicaid. And since Tennessee’s elected officials refuse to expand Medicaid, any Medicaid-enrolled students are technically uninsured while in Sewanee.
Dr. James Peterman, the director of Civic Engagement at Sewanee, wrote to me in an email that “the issue…is an instance of the national failure to have a well-conceived way to ensure that everyone has access to healthcare. The pandemic just underlines our national and state failure.”
“The last governor of TN attempted to address the gaps in the state Medicaid program, but got little political support for that.” Peterman continued, “The University Health Service and the Dean of Students have had to find ways to manage access issues in this difficult political context.”
According to Bradford, the UWC can’t take Medicare and Medicaid, despite attempting to obtain credentials in a lengthy bureaucratic process which lasted for more than 18 months. In the end, Bradford said to me in an email, “there was major red tape along the way that wasn’t getting cleared and threatened our commercial standing with [Blue Cross Blue Shield],” one of the largest private insurance companies. So, even if a student’s parent lost their job and was able to obtain Medicaid afterwards in a state like Arkansas or Virginia, that student will likely pay out of pocket for medical expenses in Sewanee.
Underinsured students with private insurance may also end up with hefty medical bills. An HMO like Kaiser might provide good coverage at their many locations and primary providers throughout Georgia, South Carolina, Colorado, and other states. However, in Tennessee, Kaiser-insured students find themselves in a healthcare dead zone, without any Kaiser-affiliated pharmacies or clinics within a reasonable distance.
That said, Bradford stresses above all that no student, whether they are uninsured, underinsured, or on Medicaid, will ever be turned away from the University Wellness Center due to problems with insurance. No one, she says, should “feel that they cannot contact us for fear of their lack of insurance, their lack of coverage, and what that could mean for a financial burden on themselves or their families.”
Ideally, Bradford says, a student health insurance plan would be mandatory for everyone. Having all Sewanee students on the same plan would lower the individual cost. In a perfect plan, students would not be charged a premium, either. And even in a plan with students paying a premium, it would be covered by Sewanee’s financial aid packages.
Another option uses a concept called the “hard waiver.” Under a hard waiver, students would have to prove that their primary insurance coverage matches or bests the one offered by the college. If it doesn’t meet the hard waiver, congratulations! You have two insurances, one with the school and one at home. If it does, a hearty congratulations to you, as well. You can keep your insurance from home at Sewanee.
The biggest obstacles to any plan, as far as Bradford sees it, lie not in the cost of the insurance itself, but in the staffing.
“That’s an entire department,” Bradford said, “If everyone were enrolled in [a student health plan], it’s going to be someone who would be overseeing that insurance plan every year to negotiate, to make sure we get the best for our students at the best price. To make sure those premiums don’t go up, or the deductibles.”
I can already hear the sighs coming from folks worried about raising costs at an already-expensive private college, but Bradford thinks of it this way: as an investment in students.
“We use the Stronger Truer campaign,” Bradford said, referring to a fundraising campaign under the last Vice Chancellor, “And they talk about thriving and flourishing, and what students need in their toolbox to thrive and flourish. And the bottom line is they’ve got to know that they can be healthy.”
One of the reasons that companies like United Health and Anthem made so much money in the past quarter is because people are afraid of going to the doctor in a pandemic. Conversely, students at Sewanee often put off going to the UWC for fear that they’re insurance won’t pay for it (I know because I’ve been among them). As we enter this year, my own fear is that these two paths will converge, that health insecurity will emerge from both a terrifying new disease and from a broken system focused on profits rather than wellness.
So many other colleges already offer student health insurance. I know Sewanee likes to be unique, but this is not the arena for us to flaunt our individuality. It can’t be “good and pleasant to dwell together in unity” with a third of our students un- or underinsured. And though the creation of a student health insurance plan isn’t by any means the key to some magical utopia, it’s a step we need to take in order to ensure the safety of our student body, both in a global pandemic and after.