UC community weighs in on Affordable Care Act

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Isabel Call, a UC Davis graduate student, was denied the UC student health insurance plan — SHIP — coverage this year for proton beam radiation therapy on a rare tumor on her neck.

Any conventional radiation treatments would have damaged the tissue surrounding the tumor, but proton beams could be much more finely controlled, delivering higher doses of radiation with less collateral damage to the surrounding healthy tissues.

In order to receive coverage for the therapy, Call had to appeal the decision in a process that took more than four weeks. For students like Call, the Supreme Court’s recent decision regarding the Affordable Care Act means providing more alternative insurance options and increased affordable health care.

Last Thursday, the Supreme Court upheld the constitutionality of the Affordable Care Act by a majority vote of 5-4. The ruling also limited the law’s plan to expand Medicaid, a joint program by the federal government and states that provides insurance to low-income individuals.

Some provisions have already been implemented under the act that could impact students. In California, 350,000 young adults now have coverage through their parents’ plans until age 26. In addition, insurance companies can no longer impose lifetime limits on the amount of care a patient receives. The majority of insurance plans now also offer free preventive care.

In 2014, college students will be able to choose between using their parents’ insurance plans, their college insurance plan, insurance provided by their employer or Medicaid. Also, insurance companies will not be allowed to deny coverage to individuals with pre-existing conditions.

A UC Berkeley panel of five campus experts met Monday to discuss the various reactions toward the Supreme Court’s ruling and considered the complexity of the act.

One of the five speakers, Stephen Shortell, dean of the campus School of Public Health, discussed the effect of the legislation on California residents.

According to Shortell, the five-member board of the California Health Benefit Exchange estimates that 2 to 3 million patients in California will apply for Medi-Cal, and of the 5 million Californians not eligible for Medi-Cal, 3 million will be eligible to receive subsidies under the act.

Although Shortell said he approves of the legislation, he acknowledged that reaching out to 5 million Californians will be a challenging task and that now government leaders will need to keep reducing the increase in insurance cost while keeping high-quality health care.

Kim LaPean, communications manager of the Tang Center, said in an interview that the health center has been anticipating the act.

“Ensuring access to health care is very important to us,” LaPean said. “We have been very progressive with insurance … We have a completely insured population. All the UCs do.”

LaPean said all of the UC campuses have already pooled their insurance plans together to create one UC student health insurance plan so that the campuses can financially absorb and manage the costs of the new benefits included under the act.

Call said the act will help her financially but pointed to her experience with the act’s independent medical reviews — IMR — clause, a review process which may make it harder for students with rare diseases to fight for coverage.

“In particular, there was no evidence that the reviewers chosen would actually be independent, qualified, and unbiased,” Call said in an email. “I refused to consent to an IMR, and within 12 hours my coverage for proton therapy was guaranteed, suggesting that the IMR was offered solely to reduce my bargaining power, and not to investigate the medical consideration of my case.”

However, Call said what concerns her about the act is the guarantee of independent medical review for patients whose requests for coverage are denied.

Jennifer Haubenreiser, president of the American College Health Association, a leadership organization in college and university health, said that the act will make sure all insurance plans are of high quality and will eventually eliminate the annual coverage limit on university insurance companies.

“(The act) will, by 2014, eliminate low-quality plans,” Haubenreiser said. “In 2012, the annual limit for college plans is $100,000. Next year, it will be $500,000, and then the following years there will be no annual limit for coverage. Students won’t have to worry about bankrupting (their) families.”