Health Insurance Politics Hits Home for UCSF Students

The UC-SHIP Forum and Student Health Advisory Committee meetings in the past weeks have provided lots of concrete information about the $57 million deficit in the UC-SHIP student health insurance plan . These issues provoked us to reflect on questions about justice for students with disabilities and those living with chronic conditions and mental health needs.   

However, many of UC-SHIP’s problems also highlight connections between the experiences of UC students and systemic problems with health insurance in the United States. In this editorial, we reflect on some of these questions and connections.

News of the $57 million deficit arrives amidst intense debate about whether the UC - SHIP will change its policies to eliminate lifetime and annual benefit caps. Though the Patient Protection and Affordable Care Act (PPACA) eliminated brutal caps on benefits for some, self-funded systems like the UC-SHIP were exempt from this provision (“Health care limits leave some UC students with few options,” San Jose Mercury News, Jan. 25, 2013 www.mercurynews.com/science/ci_22453645/health-care-limits-leave-some-students-few-options ).

Currently, UCSF students have a lifetime benefit cap of $400,000 and a $10,000 annual pharmacy benefit cap (USCF Student Health Brochure https://studenthealth.ucsf.edu/sites/studenthealth.ucsf.edu/files/UCSF%20Brochure%202012-13_0.pdf).

This means treatments for conditions such as diabetes, HIV, rheumatoid arthritis and cancer can easily send students over the cap, leaving us responsible for 100 percent of the remaining costs. Just one major hospitalization could put students over the lifetime cap in benefits.

Gaps and caps in health insurance coverage and restrictions on medical leave will inevitably determine who can attend UCSF and who will struggle too much to continue as a student.

Unfortunately, insurance loopholes and budget woes are not a thing of the past in the age of the PPACA. As long as we keep a highly fragmented system dominated by for-profit health insurance companies, we will continue to face unsustainable costs and gaps in coverage, with unacceptable consequences.

These are fundamental flaws in a system that incentivizes insurance companies to skim off the most profitable patients and exclude those who need more care. The fact that even a large institution with a desirably “low-risk” population is struggling illustrates the inadequacy of PPACA and the need for a single-payer system in the United States. Until we tackle these issues, we will continue to face false choices like those facing UC-SHIP: increase premiums or live with inadequate coverage. 

Students are being asked to consider several changes to our plan: restricting care for dependents, reducing options for medical leave, increasing co-pays or continuing to impose lifetime or pharmacy caps.

Now, with a looming deficit and rising health costs, these changes are receiving increased scrutiny and attention. While it is clear that the structure of the plan will change in coming years, we face serious and fundamental choices about who will be adequately covered.  

These choices reflect our values as a community. These are not just questions of dollars and cents, but fundamental choices about our values and priorities. Who gets to be a part of the next generation of health professionals and researchers? Will it be possible for students with chronic health conditions to attend UCSF and get access to the care they need?

Will it only be possible for those who are extremely wealthy? How much extra time, energy and debt will we have to take on, when we are already stretched thin by the demands of rigorous graduate or professional programs?

While UCSF’s principles of community claim a commitment to diversity, equity and inclusion on campus, UC-SHIP policies marginalize people living with chronic and mental health needs, single parents and older students.

Equity on campus means that UCSF students must have access to adequate health care now and that campus leadership must ensure that future generations of providers and researchers include people with physical and mental disabilities.

Moreover, our campus community has to become a transformative force in our unequal and unjust health care system. While these issues hit us “at home” on campus, the problems faced by people living with chronic conditions, the uninsured and underinsured extend far beyond UCSF.

Fortunately, as a self-funded system with a Student Health Advisory Committee (SHAC) representing a collective of 135,000 students, we are in a unique position with respect to other U.S. health care consumers. Students can contact SHAC representatives to voice their experiences and concerns, and sign the petition to support eliminating the benefit caps at www.uaw2865.org/ucship/).