Is student health important to the campus? My inbox suggests it is. Last week alone, I received numerous emails from administrators and initiatives about boosting the health and well-being of the UC Berkeley community. But then I heard about the new Student Health Insurance Plan, or SHIP, contract with Blue Shield for the 2019-20 academic year — not from my inbox but through KQED. I became concerned that the campus was creating initiatives rather than fair contracts — with potential harm to all students but a disproportionate and inequitable impact on vulnerable student groups.
As a lifelong patient and chronic disease collector, a former medical social worker and a doctoral student in the UC Berkeley School of Social Welfare, I have spent my time deciphering health insurance plans, teaching others to do so and analyzing plan comparisons. A review of the information available on the SHIP website revealed a drastic increase in out-of-pocket expenses for all students while having a particularly harmful impact on students with chronic illnesses or disabilities, low-income students, student-parents and anyone who might have an emergency in the 2019-20 academic year. This policy requires immediate attention and resistance; many are not aware of the change or how it could impact the student body.
SHIP has ended its contract with Anthem Blue Cross, a company accepted by many providers because of its fair and reasonable reimbursement rates. Instead, the university has chosen to provide insurance through Blue Shield, which does not reimburse providers as well. Students have already discovered that their providers, such as therapists, will no longer accept SHIP as payment now that Blue Shield is the carrier. This impacts clinicians of all types but is of particular concern when it comes to mental health treatment, as the relationship with one’s particular therapist is key to treatment.
For all students, the plan includes a 10 percent increase in premiums — the portion that you pay each semester, among other university fees, just to be covered under the plan. When SHIP directors spoke to the Graduate Assembly in February 2018, they reported a premium increase of 6 percent.
But the real harm and disproportionate impact require a closer look. For student-parents or those who have dependents on their health insurance plan, the 10 percent increase hits twice. There is a 10 percent increase to cover the policyholder as well as a 10 percent increase to cover a dependent.
For all students, the current copay is $100 when they go to the emergency room. The new plan increases this amount to $250 — easily wiping away one month’s food budget in one severe asthma attack, allergic reaction or everyday accident — and waives the copay if you are admitted. Think about what the underlying message is here: If the prohibitively expensive copays go away when you are admitted, then you are being encouraged to only go to the ER when you are gravely ill or injured, with the implication that most ER visits are frivolous, unnecessary and could have been avoided if you had simply scheduled your emergency around the hours of the Tang Center primary or urgent care clinic.
In conversations with others on campus who have chronic impairments, I’ve heard students’ survival planning, and it goes something like this: “I know when my symptoms are getting to the point where I can’t manage them on my own, and if it’s the middle of the night, my only choice is to go the ER. But with this new copay, I’d just wait until I felt really sick and know I’d be admitted.”
For some of us — perhaps not the “most students” referred to on the SHIP website who likely won’t be impacted by these changes — ER trips are inevitable aspects of living with chronic impairments.
The opening of the Basic Needs Center on campus is a critical step toward supporting a diverse student body. It provides essential services and recognizes that there are poor students on this campus, even if not “most students.” The $250 copay is designed to discourage ER visits and incentivize students to make more use of primary and preventive care. But there are unavoidable emergencies, and not all students have the privilege of availability between 8 a.m. and 5 p.m. when the primary care clinics are open. Thus, this financial disincentive of ER use could disproportionately impact low-income students, potentially leading to dangerous medical situations. Disabled people are more likely than their nondisabled counterparts to be low-income at any age or education level. We are also overly represented in other marginalized groups on campus such as veterans, formerly incarcerated students and nontraditional students of all kinds.
The new SHIP plan drives up inequitable barriers to higher education for all of us who already have them. Before you get sticker shock and go off to ask your premed friend to wrap up your broken arm, arm yourself with knowledge about the plan, write about how it will impact you in a Google form, and sign a petition opposing the new SHIP plan.