• There are more than 45.8 million Americans today without health insurance, a number expected to increase to 56 million within the next decade. As much as 10 percent of the uninsured population is composed of college students.
• Young adults make up the largest age-group of uninsured Americans; nearly one in three of the uninsured are between 18 and 24 years old.
• Colleges and universities in states such as Massachusetts, California and New Jersey have implemented programs that require health insurance coverage as a condition of college enrollment.
• Aetna supports legislation that requires all students to possess private or school-sponsored health coverage before enrolling in a college or university.

Background

With health care costs continuing to grow at double-digit rates, the number of those without health coverage will continue to escalate. Forty-five million Americans are uninsured already, and the number is expected to increase by 11 million more within the next decade. The Institute of Medicine attributes 18,000 deaths a year to a lack of coverage¹. In addition, 42 percent of the uninsured have no usual source of care — they miss out on preventive screenings and care for chronic conditions such as cancer, diabetes, cardiovascular disease, mental illness, HIV and end-stage renal disease.²

The uninsured are not a homogeneous group. A comprehensive variety of solutions — both public and private — is necessary to bring low-cost, high-quality health care to a population that includes college students, small business and low-wage employers, and racial and ethnic minorities.

The College Student Dilemma

For college students, health insurance options are limited. They may rely on their parents' coverage as a dependent, purchase their own school-sponsored coverage, or simply “go bare.” Many employer-sponsored plans have age-based cut-offs for dependents at either age 19 or 23, leaving part-time and graduate students with fewer health coverage choices.³

Aetna's Solution

Targeted solutions for groups such as college students can effectively reduce the number of uninsured. The Chickering Group, an Aetna company, is the nation's largest supplier of student health insurance plans providing colleges across the country with affordable health care coverage options for young adults. Offering plans with a customized approach, Chickering is providing access to the quality services that students need most.

Aetna also supports legislation and other efforts that would require undergraduate and graduate students enrolling in a public or private college or university to have health insurance. For example, under a program similar to the Massachusetts QSHIP initiative, a student would have the option of providing a “hard waiver” — documentation proving participation in a health plan — or becoming a member of the institution's health plan. As an incentive to schools, the cost of the health plans could be included in the annual cost of attendance (COA, under Title IV of the 2004 Reauthorization of the Higher Education Act), allowing students who receive a partial or full financial aid package to receive assistance for health care costs. Such a program, which has been estimated to cost the government $1 billion to $2 billion or just 2 to 4 percent of the annual budget allocated to reduce the uninsured, would effectively eliminate up to 10 percent of the uninsured population. Other possible incentives include federal financial support for schools (National Institute of Health funding for school medical centers) and direct subsidies for students (that is refundable tax credits).

Questions and Answers:

Q: Wouldn't such a requirement make it harder for students to afford secondary education?
A: The cost of a college health care plan could be included in the cost of attendance (COA), which currently covers college expenses like tuition, room and board, transportation, books, and miscellaneous expenses. Expenses included in a student's COA qualify for financial assistance from federal aid and grants, scholarships, work-studies, and student loans. Two million college students already purchase health plans in this way. A typical university plan costs between $800 and $1,400 per academic year, depending on the amount of coverage, types of benefits included, demographics, available university services, and the local health care market.

Q: Do college students need health insurance?
A: Yes. It is estimated that college students incurred from $100 million to $300 million in uncompensated inpatient medical expenses in 2004 alone. Those without insurance also miss out on preventive care for chronic conditions such as cancer, diabetes, cardiovascular disease, asthma, and HIV. Nearly two out of three uninsured young adults don't seek treatment due to cost or have trouble paying medical bills.

Q: Can't college students be insured under their parents' employer-sponsored plans?
A: Many are currently covered, but age-limits for dependents typically end coverage at age 19 or 23. Furthermore, a study by The Commonwealth Fund in 2005 indicates that nearly 60 percent of employer-sponsored plans require students over the age of 19 to attend school full-time in order to qualify as a dependent. While 18 percent of full-time students were uninsured in 2003, 36 percent of part-time and non-students were uninsured. And, as health care costs rise, more employers are dropping dependent coverage altogether.

Q: Wouldn't a single-payer system eliminate the entire uninsured problem?
A: A single-payer system, such as those in Canada, Britain and Germany, places the financial burden of health care on the government and taxpayers rather than the consumers who are most capable of determining their health care needs. In a single-payer system, the government determines the budgets for hospitals and fees for individual doctors. A limited budget for health costs means that services must be rationed — from the number of patients a doctor may see to the number of babies a hospital may deliver. These capped budgets also curb access to innovative medical technology and services.