Idaho college students caught in Medicaid gap

Amir Piranfar is among the next generation of health care providers — a third-year doctoral pharmacy student at the Meridian campus of Idaho State University.

But as he planned for his spring semester, the future of his career hinged on taking out student loans to pay for health insurance that is required to attend a public university: about $155 per month for a policy he figures he will never use, because it has a nearly $7,000 deductible.

It’s a stark change from this year, when Piranfar paid about $20 per month for coverage with no deductible and tiny copayments.

The only difference? His schedule.

Piranfar is heading into the demanding final stage of his education. He won’t have time to work. This year, he had an income that was just barely above poverty level, hitting a threshold for federal assistance that made his insurance so cheap.

But he will earn too little money to qualify next year. And he doesn’t qualify for Idaho’s bare-bones Medicaid program, which has not been expanded to include low-income adults. Piranfar is almost 27, so he cannot take advantage of the Affordable Care Act provision that says children can ride along on their parents’ insurance until age 26.

Piranfar and an estimated hundreds more Idaho college and graduate students fall into a coverage gap. They have been required to pay thousands of dollars for insurance or risk being dropped from full-time attendance.

At the same time, the state no longer requires four-year public colleges and universities to offer students the option of buying a school health plan.

“I wish they had it now,” Piranfar said. “I mean, yeah, it (was) pretty expensive but ... their deductibles weren’t $7,000.”

Now that they understand these students’ plight, state education leaders say they will try to help. The State Board of Education has just voted to waive the insurance requirement while it figures out a permanent solution.

THE GENESIS OF A PUBLIC POLICY GAP

About 15 years ago, the state board imposed a new rule: Full-time students at four-year Idaho public institutions of higher education must be insured.

“When this policy was first implemented, we were experiencing a number of students who were having some type of major medical event, and they weren’t insured, so they went to the local hospital,” said Matt Freeman, the board’s executive director.

Those students’ bills often went to the counties and the state under Idaho’s taxpayer-supported system for indigent medical care.

“That was the genesis” of the policy requiring insurance, he said. “That basically remains the main focus — a fundamental belief that students should be insured.”

A board spokesman said students also may be more likely to get preventive care, and keep the campus healthier, if they have insurance.

Recognizing that students could not always simply sign up for insurance in the pre-Affordable Care Act era, the board ordered the schools to offer student plans.

Within the past year, the board revised that policy to say that students must have insurance that complies with the Affordable Care Act, not cheap stopgap plans. It also said schools no longer must offer a plan option.

One of the schools to discontinue its plan was Boise State. About 2,500 students at BSU had been on the school’s plan at the time, The Arbiter, Boise State’s student publication, reported in March.

A compliance official at Boise State told the Statesman that the school has yet to kick a student off the enrollment rolls due to lack of health insurance.

The university now is considering whether or not to seek bids for a new insurance plan for students.

“We are all in quite a quandary right now,” said Stacy Pearson, vice president for finance and administration at Boise State University. “We just didn’t realize that health insurance was going to become such a large challenge.”

TAKING URGENT ACTION

Several students told the Statesman that their school plans were better, or cheaper, than their options now. A graduate student at Idaho State University in Pocatello whose SHIP premiums — student health insurance plan — were covered in her teaching-assistant compensation package told the Statesman she now must buy insurance, reducing her overall income.

“Students and their families are also facing steep increases in prices for policies offered on the state exchange, with average prices for a minimal coverage ‘bronze’ plan exceeding $200 per month,” according to a staff report prepared for the education board’s Dec. 9-10 meeting in Twin Falls.

One of those students is Andrea Woodyard, a Boise State junior in her 40s who is studying social work.

Woodyard used to have SHIP for about $200 a month. Now she has “not a very good” Blue Cross of Idaho plan from Idaho’s insurance exchange that costs more than $350 a month.

Woodyard’s father is helping pay the bill. She has not used her insurance, she said, because the deductibles are too high.

Health plan costs are growing “almost as much as the tuition is,” she said. “Most people are getting student loans to pay for health insurance.”

Freeman told the Statesman that he had not heard of students taking out loans to pay for health insurance, though it is an “allowable expense” for student loan dollars.

The board staff also noted that its policy strays from the Affordable Care Act. As far as the federal government is concerned, Piranfar and Idahoans like him are exempt from the act’s mandate that all Americans either have health insurance or pay a fine, because holding them to it would cause too great a hardship. The federal government has carved out more than a dozen exemptions, from low income to life troubles such as eviction, homelessness or domestic violence. The education board’s policy does not recognize those.

“Some of these students have established arrangements through clinics and other charitable organizations to provide for medical care while attending college on extremely tight budgets,” the board’s December meeting materials said.

Woodyard goes to Terry Reilly Health Services — a network of federally supported community clinics in Ada, Canyon and Owyhee counties — for free care.

“Administrators at the four-year institutions and board staff members have been besieged by students and families who, under the current wording of the board’s policy, may not be able to continue with their planned studies,” the board’s agenda said. “Hundreds of students are affected by the scenarios described above.”

The board decided at this month’s meeting to rethink its policy. It voted unanimously to waive the requirement until the board passes a new policy, or Sept. 1, 2016, whichever comes first.

A PERMANENT SOLUTION?

When he learned of the board’s decision, Piranfar sighed with relief. He said he had been working the phones trying to explore his options for the past couple of months.

Instead of a catastrophic plan from the exchange, Piranfar now plans to get a Blue Cross of Idaho temporary policy. It costs about $70 a month, but it doesn’t offer the same benefits he could get on a regular ACA-compliant plan. Still, he expects to save a lot of money.

As a health care worker, Piranfar believes the temporary waiver is not the right answer. He thinks the solution rests in the hands of state lawmakers.

“I think they should expand Medicaid here,” he said. “I see people who are uninsured all the time, who get into financial trouble because of it.”

Woodyard agreed that Medicaid expansion would be a solution.

Piranfar will wrap up his education with an internship in Reno next May.

Now he’s thinking, “Maybe I could just get Medicaid when I move to Nevada.”

This story was originally published December 19, 2015 at 11:43 PM with the headline "Idaho college students caught in Medicaid gap."