Monday, March 23, marked five years since President Barack Obama signed the Affordable Care Act into law. With over 16 million people now insured through the ACA, low-income students in particular have more to consider with regards to health care. Some students have expressed concern that low-income students have not been well informed about health care services available at Swarthmore.
In 2014, the ACA began to apply to all college students, meaning that they must abide by the law’s individual mandate. Along with other U.S. citizens and individuals of non-immigrant status, students with eligible incomes must obtain insurance or pay a tax penalty. Those with incomes below a certain threshold may qualify for Medicaid, which provides government assistance in paying for health insurance. Pennsylvania is one of the states that took up the ACA offer of Medicaid expansion, making free to low-cost insurance available to Pennsylvanians with incomes up to 138 percent of the poverty level. The Department of Health and Human Services determines a $16,105 income for one person to be 138 percent of the federal poverty level in Pennsylvania.
This means that Swarthmore students now have more healthcare options. The ACA allows students to stay on their parents’ health insurance plan until the age of 26. As more low-income families acquire healthcare, more young adults can be covered at school. However, just as before the ACA was enacted, the farther away students are from home, the less likely it is that they will be in an area that has a doctor covered by their insurer’s network. Other options are for students themselves to partake in the “exchanges,” online marketplaces for obtaining insurance through the ACA, or to purchase the college health insurance plan.
The college health insurance plan costs $1,183 for one full year of coverage. This is lower than the national average for the ACA’s Bronze plan, the lowest form of protection. It offers 60 percent coverage, which the Internal Revenue Service determines to be $2,448 annually. The college’s insurance generally covers 80 percent of expenses, surpassing the coverage of the Bronze plan. It has a $100 deductible, which is the maximum price an individual pays before they start receiving coverage, and also meets the ACA standard of minimum essential coverage. The plan, however, does not cover long-term care. Students may also opt for a discounted rate of the college insurance plan if they cannot pay the $1,183 sticker price. This discount is based on the financial aid a student receives.
The benefits of the ACA and the college’s insurance plan are more likely to be taken up by students from low socioeconomic backgrounds. However, low-income students have unique experiences and concerns that may inhibit them from using such services. In particular, lack of both clarity and medical information has been a problem for low-income students.
Swarthmore Organization for Low-Income Students member George Abraham ’17 stressed the importance of making students aware of transportation choices and costs when traveling to off-campus centers for severe health ailments. Abraham had an infection in his finger that Worth Health Center could not treat. He was told he would have to go an urgent care center facility.
“The nurse told me there was a cab voucher available, which would charge my parents for the costs incurred, so I decided to take a Zipcar instead because I thought it’d be cheaper,” wrote Abraham in an email. “[D]ue to the wait at the Urgent Care … I incurred a late fee from Zipcar, and the trip ended up costing me $75.”
He went to Worth to talk to Beth Kotarski, who was the director of the health center at that time.
“She was … helpful and sympathetic towards my story and frustration,” Abraham wrote. “We both determined that the core problem was misinformation: the nurses should have warned me that if the infection got worse, I’d need to go off campus … [and] I could have planned ahead. The nurses should have told me that the cab vouchers give me a big discount on my ride to and from the urgent care, and it would’ve been much cheaper to go this route actually.” He ended up receiving a late fee refund from Zipcar.
Maria Warnick, the Interim Director of Health and Wellness Services, pointed out free services available to students. Many of the medications at Worth are free. The lobby has a “cold center” with free over-the-counter medications for minor illnesses and first aid supplies.
“All provider visits … are free of charge … There is also no limit on the number of visits any students may have over the course of the school year,” wrote Warnick. “The Health and Wellness Center also provides unique services such as free travel medicine consults which often carry an initial $100-200 consultation fee at a travel clinic to all students who are studying abroad.”
She listed other medical services available free of charge. The Health Center gives out immunotherapy or “allergy shots.” Crutches, nebulizer machines, and other medical equipment can be loaned to students for short-term use. Last November, students could receive free HIV testing, a service Warnick expects the college to offer again before this semester ends.
Warnick explained that some medicines at Worth do carry a fee, but can be discounted or waived if the student cannot pay.
“The most important thing for students who may be struggling with health care costs to do is to let someone know of their burden. We cannot help if we do not know,” wrote Warnick.
Students may not bother seeking out medical assistance if they are unaware of free services. Abraham described how when speaking to the director, she told him about resources he had not known existed. He also later learned that the health center has a website showing what treatments are available.
“Right now, I know certain individuals who are afraid to go into Worth because they feel Worth is unhelpful and cost-inducing,” Abraham wrote. “Some friends of mine thought Worth was too upfront… [and] tried to shove too many expensive medicines at them, which could be intimidating for lower-income students.”
He wrote that medical care is available, but greater effort must be taken to deliver this knowledge to low-income students.
“I am convinced that … if people need medical help, the school will do its best to offer financial assistance if necessary,” wrote Abraham.
He believes that the college should help make low-income students more comfortable asking for medical help. The college could foster this comfort by not being overly precautionary and by telling students that costs are negotiable and may not be so daunting. Abraham wrote that proactive methods, such as programs or talks from Worth, may be utilized to inform low-income students of available resources.