This article is the second in a two-part series examining student health insurance. The first section looked at student insurance programs statewide. This article focuses on health insurance at Tufts.
The Student Health Organizing Coalition (SHOC), a Tufts-based organization that seeks to bring a student voice to discussions on student health insurance, is taking a magnifying glass to Tufts' student health insurance plan, as group members work with legislators to push for statewide reform.
The release this month of a state-sponsored report showing that insurance carriers are making higher profits on student health insurance plans than those for the average client spurred students to take action.
Health administrators at Tufts maintain that the process to reform student insurance is far more complicated than many think. The report's findings, they say, shed light on issues that they are continuously trying to address.
According to the Student Health Program Baseline Report, Aetna Student Health, the provider for Tufts students' insurance, had an average profit margin of 14 percent for the Tufts plan compared to the 2 percent industry average for non-student insurance plans.
The report also found that insurance carriers spend 88 percent of their non-student premiums on medical expenses on average; for Aetna's student plans, 68 percent goes toward medical costs.
SHOC members see the report's findings as reason to urge Tufts' administrators to reevaluate students' health care needs.
"In addition to trying to reform this on a state level, we're really focusing on changing the Tufts plans," said junior Vivian Haime, an SHOC organizer. "As we started meeting with students at Tufts and hearing about their problems, we really felt we needed to address the problems at home."
But Senior Director of Health and Wellness Service Michelle Bowdler said that the report was not necessarily an accurate representation of the situation at Tufts, where about 50 percent of graduate students and 20 percent of undergraduates purchase the Tufts insurance plan.
Bowdler explained that the situation was more complicated than the report suggested and said that the report's focus on the two academic years between fall 2005 and spring 2008 provides only a snapshot of the bigger picture.
She cited an arrangement with Aetna in which part of the profits in excess of the target specified in the contract would be applied to student health insurance for the following year.
Senior Elisabeth Rodman, another SHOC organizer, said that though Tufts' health insurance offers low premium costs, its structure is problematic. "Although premiums are low, there are extremely high-hitting costs throughout the plan," she said. "There are certain types of exclusions and limitations that make students' health insurance unaffordable."
One such limitation in the Tufts plan cited by SHOC organizers is a $1,500 cap on prescription drugs, which has caused problems for students. "It means that if you have a chronic condition, the Tufts plan only covers prescriptions for three to four months and you have to pay the rest out of pocket," Haime said. "It has led a lot of students to forego treatment."
SHOC members shared the testimony of one graduate suffering from endometriosis, a uterine tissue condition that causes considerable pelvic pain. Her treatment costs about $400 a month and the financial strain forced her to choose between pursuing her education and getting treatment.
Bowdler said that crafting an adequate insurance plan that met all students' needs was a difficult balancing act. Increasing the prescription benefits for situations like that of the graduate would raise the premium for all students on the plan. The cost of insurance would increase to meet the needs of a minority of students suffering from severe conditions.
"When we look at how many people are going over the $1,500 cap, one year it was like 12 students. If we decide to raise the pharmacy benefit next year, with each choice like this there is a cost; the premium goes up," Bowdler said. "We use student input and data to try to come up with a plan that meets a majority of students' needs."
Doctoral candidate David Proctor, a classics department administrator who served on the Graduate Student Health Advisory Board for a number of years, said that although the Tufts plan still has problems, it has noticeably improved.
"I've seen a lot of positive change over the last five to six years, there are still problems … but overall there's been a tremendous improvement," he said. "There's also been improvement in Health Service's work in trying to feel the pulse of the community."
Bowdler emphasized that the administration is working with SHOC and responding to the group's concerns.
