Students lack insurance during pandemic

Colleges and universities across Connecticut reacted swiftly to the COVID-19 pandemic by closing campuses and moving to remote instruction. In seeking to protect students, however, some schools overlooked a crucial health care necessity — insurance coverage for off-campus students. Because Connecticut has not passed legislation regulating coverage under student health insurance plans, students at two of the largest institutions in the state, Southern Connecticut State University (SCSU) and Yale University, face potentially serious gaps in critical insurance coverage. Immediate state action is needed to ensure that Connecticut’s students have access to the health care they need — or will need — in this critical time.

Although the minimum essential coverage required by the Affordable Care Act (ACA) covers some student health insurance programs (SHIPs), it does not require that schools provide university-sponsored insurance to their students. It also leaves socalled “self-funded” plans like Yale’s completely unregulated. To address this regulatory gap, states such as Massachusetts have passed laws requiring all students to be enrolled in “qualifying student health insurance programs” that meet or exceed the coverage standards of the ACA. Because Connecticut has no such law, students in the state are insured via a patchwork of insurance policies, a number of which plainly provide inadequate coverage for students who now suddenly live outside of the state. And while some students under 26 years old are privileged enough to remain on their parents’ health insurance and thus have better access than Connecticut law requires, many are not so lucky.

SCSU’s policy is clearly inadequate because it does not require students to be insured as a condition of attendance. SCSU has offered to provide some telehealth services for its students, but medical licensure and telehealth restrictions in many states restrict use of these services. Although its website lists a number of resources for obtaining other coverage, this policy disregards the staggering number of young adults who remain uninsured despite available options. This number is likely to have increased since the elimination of the ACA’s tax penalty for those who do not obtain health coverage.

Other institutions, like Yale, offer insurance to their students that provides inadequate coverage for the large number of students who are now off-campus — many suddenly and through no choice of their own. That’s because Yale’s plan generally requires students see a very limited network of providers: Yale’s own doctors. Although Yale Health stated that it will expand its coverage outside of Connecticut for “medically necessary treatment for chronic conditions” and obstetric care, the policy requires students to “wait for approval” before booking an appointment, and coverage is not guaranteed. Final decisions about coverage will only be made after the visit, and once documentation from a provider is submitted. This requirement makes it impossible for students to know in advance what care will be covered and to know whether they will be treated equitably to other students. It also will cause significant uncertainty and stress — particularly for lower income students.

Yale Health also informed students that the expanded provider network does not apply to preventive care, which includes things like routine physicals, vaccinations, and STD testing. These services will become increasingly critical the longer students remain off campus. Recognizing this, institutions in states that regulate self-funded SHIPs — such as Harvard University in Massachusetts — have offered to provide coverage for preventive care such as vaccinations and routine physicals. Coverage for mental health conditions, which could be classified as preventive care in some instances, is unclear under the current policy, which requests that students with mental health concerns call Yale Health “for advice and options.” And unfortunately, legal restrictions on cross-border telehealth in some states will severely limit students access to Yale-based mental health providers.

Finally, although Yale Health Pharmacy will authorize early refills for some medications, students may be subjected to high out-of-pocket costs. Even with “expanded coverage,” if a student picks up a prescription from a local, non-Connecticut pharmacy, they must pay the full cost of the medication up front. A claim form for reimbursement may be filed at a later time. If left unclear and unchanged, Yale’s policies will further burden students from lowincome families, and will likely worsen access to care.

In comparison to Yale and SCSU, students at some other Connecticut institutions, such as the University of Connecticut and Central Connecticut State University, are covered by major, nationwide insurers (Wellfleet-Cigna and Aetna, respectively). These insurers have online portals for finding doctors and transparent reimbursement policies. This increased access for all students comes despite the fact that most students at UConn (almost 75 percent in 2016) and CCSU live in Connecticut. But without state regulation, these schools do not need to provide this level of coverage.

Students in states that require and regulate coverage under SHIPs do not face the same gaps in coverage and barriers to care that thousands of Connecticut students face today. Although SCSU and Yale are identified here because of their size, any college or university in Connecticut has the option of similarly restricting coverage.

Burdens imposed by the state legislature’s silence fall predominantly on students with chronic conditions, mental illness, and low income status. Connecticut should take immediate legislative action to ensure that all students have adequate insurance coverage. To allow piecemeal insurance practices to continue would fail to protect those most vulnerable during this time of need.

Blake N. Shultz and Evan Walker-Wells are residents of New Haven. Shultz is an MD/JD candidate at Yale School of Medicine and Yale Law School, and a fellow at the Solomon Center for Health Law and Policy. Walker-Wells is a JD candidate at Yale Law School.