Going Without: Grad Students Face Increasingly Tough Choices Over Health Care
Across the country ‘Cover the Uninsured Week,’ observed April 23 through April 29, will serve as a platform to debate, discuss, and demand health insurance coverage for the uninsured. Much media attention was garnered on the issue last year, as reports indicated that 47 million were uninsured and an additional 16 million had inadequate coverage. Yet because estimates vary depending on the system used, others suggested that the US had over 48 million uninsured at any point in time by 2004. This crisis in coverage is a concern for everyone, but particularly pressing for graduate students who are often not covered through employment, financial aid, or significant others and yet earn too much to be eligible for public insurance programs.
The Health Issues Committee (HIC), formed during our own more immediate crisis around The Graduate Center Wellness Center, has been working diligently to identify and address the student body’s concerns. With the GC moving away from mandatory insurance coverage and toward finding cheaper alternatives than the plan currently available, more students may be able to afford coverage. In an informal survey conducted by the HIC in 2005, 26% of the 690 students who responded reported not having any health insurance. While the poll was quickly launched and implemented and had a very low response rate the findings are consistent with local rates of the uninsured and other college programs. According to the United Hospital Fund, 22% of the residents of New York City are completely without insurance. A Florida State University poll conducted in 2004 found that as much as 30% of graduate students enrolled at the university were not covered by health insurance. A more recent study at the University of Arkansas found that 40% of the graduate students that responded were uninsured although, according to The Arkansas Traveler the national average is 20-30%. So, while locating a cheaper and more comprehensive plan is a step in the right direction, the reality is that this problem is in fact more systemic and one we will continue to face while studying and even as we enter the marketplace.
As graduate students and part-time employees, often working as adjunct lecturers from semester to semester without any job security, many of us do not have access to the same benefits as full-time, salaried, or permanent workers. However, the increased prevalence of non-standard workers (e.g., part-time, temporary, fee-for-service or contract employment arrangements) is not specific to academia but part of a global push for minimal government, decentralized services, and expanded markets. In the efficiency and productivity driven reforms stimulated by the World Bank and the International Monetary Fund, public goods, such as education and health, are looked upon solely as commodities and products. So, to reduce costs and increase profits in bringing these services ‘to market’ workforce reductions, containment of personnel costs, and ultimately any variety of outsourcing is used. If you’re unsure what this really means, think Walmart. Their reliance on part-time workers with few benefits to keep down costs is emblematic of the larger squeeze.
In the US, the Census Bureau’s 2004 statistics found that approximately a quarter of the work force has become “non-standard” with significant health consequences. Besides the obvious implications for income-security, studies published by The Commonwealth Fund in 2005 indicate non-standard workers’ access to employer-based benefits is diminishing with 60% down from 70% in the late 1970s having insurance. As well, these workers are becoming increasingly dependent on health insurance benefits offered through the government or their spouses, with 41% experiencing a lapse in insurance at some point in the year
A number of students who responded to a recent post on the DSC website asking for health insurance concerns talked about being underinsured or experiencing a lapse in coverage and the toll this has had on their ability to focus on completing their respective programs. One, Ellen Zitani, avoided incurring thousands of dollars of health related costs when covered for a short-time by GHI, but is now faced with the stress of being underinsured. Zitani said:
Unfortunately I am again, currently uninsured except for a hospitalization policy. I have bought a hospitalization policy that will cover accidents and injuries, but cannot afford (again) the insurance that would enable me to go to see a doctor should the need arise…routine care [is not covered]. With the cost of living, the demands on our time as students and teachers, I simply could not keep my second job and succeed at The Graduate Center.
Another student, working as an adjunct who asked to remain anonymous tells a story of having learned she was not covered when her insurance company refused to pay thousands of dollars in surgery costs. She said that she was dropped from coverage three days before her surgery.
No one at the college, Human Resources, or PSC had told me. With a fat hospital bill, it was too late to get any other affordable coverage retroactively. Therefore, [I] am scrambling to get COBRA, which costs about half my teaching salary.
While this student has since learned she was in fact covered, she spent an inordinate amount of stress and time that could have been better spent meeting academic demands, navigating an impersonal and labyrinthine benefits and health insurance system.
The PSC-CUNY Welfare Plan offers adjuncts currently teaching at least two courses per semester CUNY-wide, access to good quality health insurance. Yet, maintaining this coverage, as you can see, requires students to spend an inordinate amount of time focused on their health care needs rather than their academic or professional responsibilities. Chong Wojtkowski, Co-Chair of Student Affairs of the DSC, spoke to this dilemma directly, saying:
I had spent my first year at The Graduate Center without any form of health insurance…after teaching two classes at Hunter, two semesters in a row, I finally qualified for the Professional Staff Congress’s Welfare Plan. Empire Blue… is a fantastic program; gynecological visits, primary care visits, and prescription drugs and more are all covered with co-pay and up until a year ago, no deductible. For this I pay nothing, just my union dues. For this reason, each time my department has offered me a Graduate Teaching Fellowship, which would increase my adjunct salary by a couple thousand dollars, and guarantee me two courses at Hunter, I have categorically refused. This is because there is no provision for health insurance for GTF or Graduate Assistants A or B. One earns quite a bit more money, but the costs of CUNY’s only health plan equals the additional money one earns as a GTF (fancy that!).
Often, however, students are not aware of the tradeoffs needing to be made. Ellen Zitani noted:
I had thought that I would get insurance from adjuncting two semesters in a row, but only recently found out that Chancellor’s Fellows are not allowed to get insurance from the PSC like other adjuncts.
Hence, students too often have to decide between a guaranteed income in the form of fellowships and assistantships or remaining in the precarious position of adjuncts in order to keep their health insurance coverage. Although these dilemmas are fundamentally the result of being a graduate student, and may seem to come with the territory, they echo the challenges that many of us will face when we enter fully into our respective fields as employees.
Increasingly, employment-based health insurance is being eroded: from 2000 to 2004 the number of American workers covered by employers regardless of status decreased from 64% to 60%. Data sources consistently indicate that approximately a fifth of the uninsured population is working. One of the reasons frequently cited for this high percentage of uninsured employees is, of course, the fact that the cost of health insurance premiums have, according to the Commonwealth Fund, increased 87% between 2000 and 2006. Meanwhile the rate of inflation from January 2000 to December 2006 was less than a quarter of that at 19.55 %. At the same time, employers are increasingly turning to high deductible health insurance plans or discount cards as they attempt to continue to offer some level of coverage as health care costs balloon.
President George W. Bush, in his 2007 State of Union Address, promoted a tax incentive to expand private insurance coverage and improve portability. Basically, the proposal calls for the reporting of employer-sponsored health insurance as income in exchange for a standard deduction ($7,500 individuals/$15,000 families) where the employee would receive the entire deduction even if the employer spends less, but the deduction remains unchanged if the employer spends more. The intent is to spur competition as employers and workers alike would be encouraged to identify and purchase less-expensive insurance. Through this plan, the Treasury Department estimates that five (5) of the 47 million uninsured would gain access to coverage.
Beyond the obvious fact that 42 million people would remain uninsured; by focusing on market solutions rather than on comprehensive coverage, the plan fails to consider a number of key problems. In particular, insurance costs are based on risk and for individuals with more than minimal risk or with a history of pre-existing conditions finding low-cost insurance is a lot like looking for the proverbial needle in the haystack. Additionally, health premium differentials across groups and communities are not taken into account. The insured would need to pay insurance costs up-front and then apply for a tax refund. Hence, those who cannot afford insurance are offered a deduction they cannot use. Given the fact that tax deductions benefit higher income households the most, a tax credit would have been more relevant and appropriate to low and moderate income earners. President Bush’s proposal is not the answer. Waiting for the results of the next presidential campaign is not the answer; the answer is campaigning for coverage.
This crisis in health insurance led in 2003 to the launching of “Cover the Uninsured Week.” Organized by a diverse group of organizations including the Robert Wood Johnson Foundation, the AFL-CIO, Service Employees International Union, Healthcare Leadership Council, United Way of America, National Council of La Raza, and the W.K. Kellogg Foundation, the campaign encourages events and activities to raise awareness and mobilize for change. Closer to home, the Wellness Center will be hosting its Annual Health Fair on Tuesday, May 8th. Come take advantage of free health services, get involved, and join the debate.
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