Health Care Service Accessibility for Students at the University of Michigan
After struggling to manage being a full-time student, caring for an ill family member, and struggling with her own mental health, Sarah*, a University of Michigan student, decided to seek help at CAPS, the Counseling And Psychological Services center on campus. During her appointment, she was told that she required long-term services. However, CAPS did not have the capacity to treat her regularly, especially since her case was not critical. The CAPS professional recommended that she search for another therapist that her insurance would cover. Sarah was stressed about having to find another provider covered by her insurance, and about whether her insurance would cover mental health services at all.
Katie*, another student at the University of Michigan, was suffering from the “college cold” during the first semester of her freshman year. She felt that this cold was normal and tried to manage it on her own, as she was living in an on-campus student housing facility and most of her friends were also ill. Her general cold symptoms eventually turned into a more serious respiratory condition after a few weeks, and Katie finally decided that she could no longer delay health care. She went to the University Health Service (UHS) early in the morning in hopes of seeing a clinician before it got too busy. Unfortunately, Katie ended up waiting at UHS for five hours before being seen. Despite needing follow-up care, she has decided not to return to UHS due to a lack of time.
At freshman orientation, the University of Michigan markets its health care offerings, which are free at the point of service, to incoming students as a convenient and accessible resource. All students should be able to access and use UHS services since they are pre-paid for through the mandatory health service fee as part of tuition. While these services are needed and useful for students, the demand often exceeds the capacity. Students with health insurance may have the ability to seek services elsewhere; however, students without health insurance coverage may not have other options.
In order to avoid the long waiting times at UHS, many students rely on non-university urgent care settings. The CVS Minute Clinic right off of campus, for example, offers appointment scheduling and an online feature for drop-in visits that allows patients to join the line virtually. Many students might find it easier and less time-consuming to seek services in this manner. However, uninsured students have to pay out of pocket at any urgent care center, although they could receive free care at UHS. Lower income students, specifically uninsured low-income students, may be disproportionately affected by the difficulty in accessing care services offered at the University of Michigan.
Knowing that university health centers might not have the capacity to meet all students’ needs has caused both Sarah and Katie to delay or completely avoid seeking health care. After their initial experiences with CAPS and UHS, both students decided to try coping on their own.
Brian* was sent to the hospital during his freshman year at the university after he fell ill. While being treated in the emergency department, he was asked to provide his insurance information, but he did not have coverage. After being handed a bill for thousands of dollars, he worried about how he would come up with the funds. As an 18 year old, he was unaware of his insurance options, but hospital staff recognized that he was eligible for Medicaid. Ultimately, Brian was able to receive retroactive coverage for his services; however, he does not know what he would have done to pay for his bill without Medicaid.
Despite the presence of free healthcare services available to University of Michigan students, health insurance is often still necessary for sufficient access to needed physical and mental health care. Additionally, as the university’s free health care offerings do not encompass most specialty care or hospital services, having coverage can be crucial to staying healthy and affording necessary or emergent care.
Policies such as the Patient Protection and Affordable Care Act have reduced uninsurance rates in college student populations (Bauer-Wolf, 2018). Although U-M-specific data is not available, results from the U.S. Census Bureau’s American Community Survey (ACS) identified that at Michigan public universities, the uninsurance rate of undergraduate students decreased from 17.9% to 6.9% between 2010 and 2016 (Lookout Mountain Group, 2018). However, many students are still in need of coverage, and with the recent repeal of the individual mandate penalty, it is estimated that uninsurance rates will increase (Eibner & Nowak, 2018). Furthermore, the young adult population is typically insured at lower rates than the general population. In Washtenaw County, specifically, 4.7% of adults age 19 to 25 and 4.6% of adults age 26 to 34 are uninsured, compared to the county’s overall uninsured rate of 2.7% (U.S. Census Bureau, 2017). A 2014 survey found that the two primary reasons that young adults decide not to carry health insurance are perceived affordability and value (Deloitte, 2014). Many young adults are not aware of either the Medicaid expansion in multiple states or the federal subsidies available for Marketplace plans, which seek to make insurance more affordable for those with lower incomes. Others do not believe that the benefits of insurance are worth the price, or they feel that they are healthy enough and do not need coverage.
The Washtenaw Health Initiative (WHI) is a county collaborative dedicated to improving health and healthcare in Washtenaw County, specifically for individuals who are low-income, uninsured, or on Medicaid. WHI has a Medicaid/Marketplace Outreach and Enrollment Work Group that aims to help residents of Washtenaw County understand their options for health insurance and help individuals sign up for coverage. Students are a specific target of WHI’s outreach work. As the Marketplace enrollment period for 2019 occurred between November 1 and December 15, 2018, WHI hosted three enrollment events on college campuses in the county and distributed a total of 7,487 outreach flyers in English and Spanish. Health insurance enrollment can be an intimidating and confusing process, and WHI’s outreach efforts might encourage more students to look into coverage options.
Although health insurance can be expensive, protection to help cover costs for unexpected illness and/or injury is important. Most Marketplace enrollees receive financial assistance to help make coverage affordable, and many students are eligible for Medicaid coverage. Approximately 75% of Washtenaw County enrollees received tax credits to help lower the cost of their monthly premiums, and 37% received cost-sharing reductions to help lower their deductibles and co-pays (Centers for Medicare & Medicaid Services, 2018). Since coverage options, eligibility, and pricing all vary year to year, students may find that coverage is more affordable than they believed.
If changes are made in the future, the university’s health service offerings have the potential to better protect uninsured students and to act as a health care safety net. At UHS, implementing online appointment scheduling and the ability to join the line virtually, publishing current wait times, or adding new facilities on North Campus could make services more convenient and accessible for students. If CAPS is unable to meaningfully expand its services to improve wait times or see students regularly, students should be made aware that long term services are not usually available; they should also be aided in finding outside resources that fit their situation. In the meantime, working to ensure that students understand their health insurance options is imperative.
Caroline Adams is a senior studying at the University of Michigan.
Bauer-Wolf, J. (2018, March). After the ACA, Fewer Uninsured Students. Retrieved from https://www.insidehighered.com/news/2018/03/30/obamacare-has-led-fewer-uninsured-students-study-finds
Centers for Medicare & Medicaid Services. (2018). 2018 Marketplace Open Enrollment Period Public Use Files. Retrieved from https://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/Marketplace-Products/2018_Open_Enrollment.html
Deloitte. (2014). Findings from the Deloitte 2014 Survey of Young Adults and Health Insurance. Retrieved from https://www2.deloitte.com/content/dam/Deloitte/us/Documents/life-sciences-health-care/us-chs-young-adults-and-health-insurance.pdf
Eibner C. & Nowak, S. (2018, July). The Effect of Eliminating the Individual Mandate Penalty and the Role of Behavioral Factors. Retrieved from https://www.commonwealthfund.org/publications/fund-reports/2018/jul/eliminating-individual-mandate-penalty-behavioral-factors
Lookout Mountain Group. (2018, February). Update for Uninsured College Student Population [PowerPoint slides]. Retrieved from https://docs.hbc-slba.com/_repo/Lookout_Mountain_Group____Major_Reports/Update_for_Eight_Year_Review_American_Community_Survey_Uninsured_Student_Population_Update_2_13_18.pdf
U.S. Census Bureau. (2017). 2017 American Community Survey 1-Year Estimates. Retrieved from https://factfinder.census.gov/faces/tableservices/jsf/pages/productview.xhtml?src=bkmk