The passage of the Patient Protection and Affordable Care Act (ACA), colloquially known as “Obamacare,” will initiate a major shift in Grinnell’s health care program for all students on College-provided health care plans in the upcoming 2014-2015 academic year. With the increase of coverage mandated by the ACA, students in the College’s insurance program should anticipate an increase in both health care costs and overall program coverage, although the exact plan and specific numbers are not available as of yet. Students enrolled in separate health care programs independent from the College will generally be unaffected by these changes.

Director of Compensation and Assistant Treasurer Jim Mulholland explained that, although the College has not yet found a plan which fits what they’re specifically looking for, whichever plan is chosen will cover the newly mandated benefits.

“The changes set by the ACA will broaden the benefit structure … and health benefits will basically be unlimited, but won’t pay 100 percent of every claim,” Mulholland said. “For an illness like cancer, which can cost two million to treat, all of it will be considered payable expenses.”

CHANGES IN COST

 For example, Grinnell’s current student health care plan has a maximum coverage limit of 500,000 dollars, which means that the College’s insurance provider would not compensate medical expenses above that amount for an individual student. The ACA does not allow such a coverage limit for essential health benefits.

In addition, the College is examining health care plans for which students’ total copay, or the amount they pay out of pocket as a percentage of most treatments, will be significantly lower than the current copay of 7,500 dollars. The maximum copay allowed by the ACA is 6,350 dollars per person. Furthermore, these health insurance plans will no longer exclude students with pre-existing conditions, which would be illegal under the ACA.

Preventative screenings and prescription birth control will no longer cost anything for students finding health care services from in-network providers on the College’s insurance provider—Nationwide Life Insurance—which is the network used by many of the health care professionals in the city of Grinnell.

However, with these additional benefits comes an increased cost: student premiums for Grinnell-provided health care are guaranteed to go up alongside expanded coverage. Students currently play 1,025 dollars per year for health care, and new plans call for a significant percentage increase in these prices.

“Before, the student rate was … lower, but there are higher deductible and copays,” Mulholland said. “Rather than students paying 10 percent, they paid 20 percent, and we are currently negotiating rates for the student premium. The benefit structure has changed dramatically, so the risk is larger for the insurance company, which means students will pay more [for the premium].”

Nonetheless, Mulholland stated that administration officials are working to ensure that these costs are not passed on to students who rely upon College-provided health care and students with relatively high need will not be disproportionately burdened.

 “Financial aid takes into account the cost of insurance when we’re calculating need-based aid,” Mulholland said. “We take into account what it costs to attend college, although it doesn’t necessarily cover the insurance. It will for students with full need, however.”

Director of Student Financial Aid Brad Lindberg affirmed that the College would do its best to take care of students’ financial needs when calculating the cost of health care. 

“The Office of Student Financial Aid can assist students by providing low cost student loans to cover up to the full cost of the insurance,” Lindberg wrote in an email to the S&B. “While many students have other coverage, students in need of this option have financial aid available to them in the form of low cost student loans. According to federal financial aid regulations, the cost of health care can be included in a student’s total cost of attending Grinnell.”

Lindberg suggested that students who are unsure of whether or not they should buy the College’s health insurance coverage have many ways of determining if the College’s supplementary health insurance plan is appropriate for them. 

“Students who are not sure … should check with their parents, insurance provider, or read the helpful information on the Student Health and Counseling Services webpage for more information,” Lindberg wrote.

CONCERNS ABOUT TRANS-INCLUSIVITY

Students from the Trans Action Group (TAG) have criticized the administration’s approach to finding health care programs which adhere strictly to the baseline requirements of the ACA, which they believe has consciously left out the needs of transgender students. TAG representatives tabling in the JRC stated that they hope to see coverage for transgender students such as blood work, hormonal therapy and possibly gender reassignment surgery included in considerations of the next health care plan.

A student representative from TAG stated that the College’s lack of insurance coverage for transgender students goes against the promise of the College to care for its students and its mission of social justice.

“The current health insurance plan the College has with Student Assurance Services flat out denies coverage for students with trans-related health care issues,” the student said. “That’s problematic, because it puts a lot of students in a tough position, which to an insurance company are fairly nominal costs, but to an individual due to our system those are exorbitant costs. For a student who can’t afford it, that means they have few resources in terms of how to get this stuff covered.”

However, Mulholland argued that the increase in coverage for trans students would be prohibitively expensive for all students.

“First of all, we don’t know about these plans yet,” Mulholland said. “The ACA doesn’t mandate transgender benefits or gender reassignment surgery. … I won’t look at [trans-inclusive plans] because the costs are significantly higher.” 

Additionally, he does not want to set the precedent of students selectively adding onto the College’s current health care plan.

“I don’t want people to start looking at every little thing and keep adding things to the contract,” he said.

Mulholland pointed out that the costs would need to be weighed as they affect the entire student body.

“Trans-coverage plans need a big group to share each other’s expenses,” he said. “For a cost of 100,000 over 100 people, that would come out to 1,000 per person … Do we make benefit decisions upon individuals or a group? How do we deal with that?”

However, the representative stated that TAG’s efforts have not been the efforts or concerns of a few isolated individuals, but the concerns of the College community at large. 

“The College community clearly thinks this is a seriously issue. In four hours of tabling, we’ve received 500 signatures, which is a bit more than a third of the on-campus College community,” the representative stated. “All the students want this, not just the trans students.”

At the time of printing TAG had collected over 800 signatures, around half the student body.

The representative claimed that other colleges were not struggling to meet the costs of trans-inclusive coverage.

“I emailed a list of about 50 or 60 colleges,” the representative said. “Of the colleges that have responded regarding transgender health care costs, I’ve gotten either answers of ‘we just asked for this and it was included at no cost’ or ‘the increases in premium have been minimal’… No colleges have said that these price increases would be drastically expensive.” 

The representative also added that it would be understandable if gender reassignment surgery were not included in the plan, if the price of doing so is too far beyond the College’s consideration.

“We’d like to see hormone replacement therapy, endocrinology visits and blood tests covered. We’d like to see gender reassignment surgery covered as well,” the representative said. “I can’t comment on the additional costs of that. If the last one is drastic in cost, there’s no sense in asking for things that aren’t feasible, other than the moral reason, of course.”

If coverage of transgender students’ particular needs were provided, the representative said that getting access to health care for transgender students would not be any more of a hassle than it currently is.

“Students have had blood work ordered by local doctors for trans related things, beyond that I can’t say,” the representative said. “Since the College doesn’t cover it, they’re going to Iowa City, which provides doctors and informed consent hormone replacement therapy.”

COMMUNICATION AND AWARENESS

Cynthia Amezcua ’14 said that students should fight for any additional coverage that they want the College to provide.

“It won’t be included unless people speak up,” Amezcua said. “Students have to voice what they want for their health coverage.” 

 Given the impending rise in cost, Mulholland expressed that it is necessary to ensure that students understand what will be provided under their plans. He also emphasized the College’s role in providing better information for students, so they will be proactive concerning their own safety.

“You need to find a practitioner and identify the people who can help you with your medical needs before you get sick, not after,” Mulholland said.

He added that students can find more information about Grinnell’s health care plan through www.sas-mn.com.

Mulholland stated that many chiropractors and other practitioners in Grinnell accept the College’s student insurance plan, but because students do not know about them they are paying and not receiving the benefits.

Mulholland suggested that SGA should do more to educate students, perhaps through an information session at New Student Orientation.

“The biggest issue is at the beginning. Students need to pick up insurance cards and have it in their wallets,” Mulholland said. “You go somewhere, you have it with you. The SGA should help advertise these cards as early as possible in the year.”

The College is also trying to increase health care accessibility by eliminating redundancies. For example, the current system requires two separate health insurance cards, one for the doctor, and one to pick up prescriptions.

“Even though it’s the same company, the systems are independent and don’t communicate with one another and so we have two separate cards,” Mulholland said. “The new system will do its best to only have one student card, thereby decreasing confusion and improving efficiency.”

Amezcua wanted to make sure students explore the possibilities of Medicaid programs, which assists people of all ages with financial need.

“Medicaid [was] expanded in the state of Iowa, so students should definitely look into it and see if it’s suitable for them,” Amezcua said.

Mulholland said that Grinnell’s plan provides better local coverage, but that students should definitely inform themselves and understand what’s best for their own health care coverage in regards to exploring programs such as Medicaid. 

“Our plan is very reasonable in cost and benefit,” Mulholland said. “Nonetheless, students should take some interest in the Medicaid and find out what’s best for them.”