"Health insurance card?" the woman behind the admissions counter asked. I dug into my pockets and pulled out a square piece of paper. I unfolded it and slid it across the counter.
She inspected it with a disapproving nod.
"I'm so sorry," she said.
The paper called out for some kind of pity. My name was handwritten across a blank line on the three-by-two inch scrap, identifying mea member of the collegiate, living-on-financial-aid socioeconomic classas being insured. It was dog-eared and had once almost disintegrated in a load of laundry. I cut the card from the back of a brochure detailing my student health insurance benefits. It could have belonged to any student at Boise State. But I claimed it as mine. And there I was, passing it off as legit for the sake of the medical bureaucracy.
"You know this doesn't cover much," the clerk said.
She knew what I knew: Those flimsy health insurance cards can leave a student piled high in debt. I discovered that after getting billed for almost all of the entire cost of the work-up for a run-of-the-mill, no-big-deal headache. And I had already met the deductible that rivaled the cost of my books for the semester. I whined about the medical bills for the moment, applied for extra scholarships that year and told myself to get over it. But I couldn't get over it. What if I or a classmate became seriously ill? What if we actually needed what I started to call "real" insurance--insurance that covered more than $800 of a $3,500 MRI?
Too often, the questions come too late. The youngest of students come to college with a certain invincible mindset, said Pat Branson, Student Health Insurance Program (SHIP) manager at Boise State.
"They say, 'Why do I need insurance? I never get sick,'" Branson told BW. "It can always happen."
Some have fallen ill with chronic illnesses, even cancer. They often try to stay in school, sometimes just to hold onto their insurance. But that insurance only goes so far. Plan on fighting a bout of cancer--chemo, radiation and surgery included? Just hope your med bills don't top the Boise State student maximum coverage of $100,000. Entering school with a case of multiple sclerosis that leaves you too healthy to go on Medicaid and too sick to get private coverage? Don't count on the 2004-2005 Boise State's health insurance plan and its host of exemptions including pre-existing conditions, syringes, braces and sparse coverage for specialists and routine tests. Expect instead for the $800-plus annual student health insurance premium to cover about $400 of your current medication costs plus only $200 worth of birth control pills. And don't forget that according to one 2004 SHIP brochure, the insurance plan isn't intended to treat chronic conditions. In recent years, the plan would cover only about $30 of a $250 specialist visit.
A recent Boise State study recently found that around 13 percent of Idahoans are uninsured. The study didn't look at the underinsured, although health care advocates say the underinsured, especially students, are just as vulnerable to an uncovered health care crisis--and having to choose between accessing health care or paying for the basics such as rent or food. Unlike many of the working underinsured, underinsured students, who potentially account for the bulk of university-insured students, often don't have the income, experience or family and partner support to help them through a health crisis that threatens their education and financial future.
Catch any student walking out of the Boise State student health center and they'll likely applaud the care they've received from the Health and Wellness center's teams of P.A.s, physicians, nutritionists, massage therapists, medication assistants and counselors. When complaints arise, they usually have more to do with the services you can't obtain inside the health center's walls.
Health care advocates have long questioned the prevalence of underinsured Idahoans and the adequacy of the care they receive, but those questions were beyond the scope of the recent Boise State survey, said Julia Robinson, director of Healthy Communities Access Program. But that isn't to say that a survey of the underinsured, especially the student populations of the underinsured, isn't warranted.
"I'm sure there are students who are using our [free and community] clinics ... I assume students who have major medical needs are seen at the Family Practice or Terry Reilly clinic because they are a safety net."
The issues of the uninsured and underinsured are the same, Robinson said. Both have difficulty accessing care for chronic conditions, medication coverage and specialty services. But unlike the uninsured, the underinsured are often turned away from accessing financial help from hospital and county indigent funds. "The county is clearly set up for people with no insurance," Robinson said.
So is no insurance better than a little insurance, especially if you're a student who needs medical treatment for a congenital condition which student health insurance may not cover? Students don't have a choice about coverage or no coverage. Lawmakers made it mandatory for all students to carry some kind of insurance--a pretty good idea, Boise State graduate student Lianna Erickson once thought. But what Erickson thought was a good idea quickly turned into confusion when she tried to access online information about the coverage at the health center. This semester's incoming students had until September 2 to waive the student health coverage if they were able to prove they had coverage through some other means. But by September 6, benefits information was still not available online. The student health insurance Web page simply read, "benefits summary pending for more information: www.collegiaterisk.com." Collegiaterisk.com had no information for Boise State and notified site visitors that "We cannot find 'boise state university (sic)' Please try again."
"I wished there was more information out before the waiver," Erickson told BW. "I would have liked to look at what my options were with other insurance companies." She added she would have thought twice about enrolling in the Boise State insurance program, especially after finding out that the program doesn't cover dental care.
By mid-September, the university had posted a list of benefits online, and collegisterisk.com boasted of services such as "professional laminated ID cards sent directly to students within 48 hours of enrollment." At press time, several students told BW that they had yet to receive those professional cards, and when Erickson recently cut her finger, she had no card to show an admissions clerk.
"I didn't even know where to go because I didn't have information," she said.
Ferd Schlapper, director of student health services, said plans are always in the works to improve heath care access for students. Several students sit on the board that selects the insurance company and have some say in what kind of coverage students receive. Schlapper said those students approach the insurance plan bid process by weighing cost with coverage.
"Unfortunately, those are on opposite ends of the spectrum," he said. "My feeling is it's the students' plan, and whatever they want, we could put on that plan. But they have to understand the implications." Those implications usually mean higher premiums, Schlapper said. And he added that few student representatives who weigh in on the process tend to favor affordability over coverage. Student health committee members and leaders did not respond to BW's repeated requests for interviews.
According to Schlapper, the university's health insurance contract is typically renewed ever six years, meaning the plan a freshman signs up for in their freshman year could change little by the time they graduate or enter graduate school. But Schlapper said the school continuously works to improve care and gain feedback on the plan, and surveys indicate students want more preventative care, but also want cost-savings over coverage.
On the surface, little has changed in health care coverage at Boise State since the days when the building at 2103 University Drive changed from a fast-food hamburger joint to a student health center. But some change is on the horizon, Schlapper said. Three years ago, the university hired him to help bring student health coverage up to par with students' needs.
"They were saying they didn't do anything new to address health care needs for decades," Schlapper said.
Schlapper said the university regularly asks students about their needs, and most recently students have been asking for dental and vision coverage. While they don't have it yet, this year students will see a larger chunk of diagnostic tests covered. Students also approved a $40 fee increase to move the health center out of the burger shack and gather the health services that are currently scattered across campus under one roof. But students number heavily among the 50 percent of bankruptcy claimants who file because of medical debt.
Still, Robinson said the student insurance program is better than nothing, recalling a Montana student who opted to go without insurance then had to have his appendix removed. He quit school to pay for the medical bills. And students can't expect charity to cover their bills, she said.
"I think it's better to have some insurance than none at all."