Thank you for the kind words praising the services at Student Health. You raise excellent questions about the cost of health care on campus.
The requirement for health insurance by all students in the UNC System was established in 2009 by the UNC Board of Governors for all 17 campuses in the system. In order to allow for those uninsured students entering the system, the UNC System negotiated a plan with Blue Cross/Blue Shield in order to provide affordable comprehensive coverage. It covers not only outpatient care but also hospitalization and emergency department visits. NC State SHS gives feedback for the inclusion of critical services and on the out of pocket costs each time the plan is up for renewal. Other insurers also submit proposals, and the choice is decided on by the UNC System offices. Student Health Services does not decide on the plan, does not purchase the plan and does not manage the plan.
As you explained, each semester, students waive out of purchasing Student Blue by submitting proof of other health insurance. If they don’t provide this documentation by the deadline each semester, they will be required to purchase Student Blue in order for the university to be in compliance with the policy and ensure the student has health insurance. This is not a fee but rather a charge for the purchase of health insurance. We review the data on who has waived out. We then look to be sure we are in network with the major insurers to avoid additional expenses for the students when they utilize these services that generate an extra charge.
Annually, we also pay attention to who has waived out because they have Medicaid. Currently approximately 500 students waive out because they have Medicaid. We can see these students in Student Health, but any lab tests or prescriptions MUST be ordered by a Medicaid provider, so we cannot do that, and they will need to be seen by someone else. We have considered becoming a Medicaid provider, but the administrative burden for being a Medicaid provider is large, and we estimate we would need 2 additional administrative (non-clinical) staff members just to handle this even for a small number of students. Since we are funded solely by student fees and generated revenue, we predict that those positions would have to come out of increased student fees. It is, sadly, like so many other health care decisions, a choice of raising costs or providing services. Certainly, if more students have Medicaid we will re-evaluate our decision.
We work very hard to accommodate students with financial needs while delivering quality care. We have worked with the Student Ombuds and directly with insurers on behalf of the students to try to make the student’s out of pocket costs as reasonable as possible. Our costs for laboratory tests, prescriptions and over the counter products are below the Raleigh market costs.
The issues addressed are very real. Health care costs in the US are very high and impact those most likely to need health care yet are challenged to purchase it. SHS is constantly evaluating and re-evaluating how we balance our quality services while making it affordable.
Julie Casani, MD, MPH, is the director and medical director of Student Health Services.