Health Care: Now and the Future

The doctor visit is over and the assistant behind the counter promptly asks, “How will you be paying today?” There’s a slight pause — a shift in eye contact.

Attention is drawn to the total dollar amount blinking on the screen. Breathe.

If there is health insurance coverage, an upfront payment of a smaller co-pay is in order… But wait, what the hell is a co-pay? (Check out our Health Care Reference Guide to find out…) And if there is no health insurance, what do all those other numbers mean?

Family health care plans often cover students until graduation or up to a certain age. Yet with graduation dawning, some students are quickly discovering that their parents’ health insurance is no longer going to cut it. Breathe again.

SPM has the tools to help discuss, discover and decode health care coverage for upcoming grads, or students who just don’t quite grasp what all the numbers really mean.

Still in College

For those lucky enough to still be in school but who are not covered under someone’s health insurance, there are a couple affordable options.

Dr. Allan Markus, the director of ASU Campus Health Services, says the Arizona Board of Regents (ABOR) has an Aetna plan available for current students.

“That plan is pretty close to a full plan. What it does is it allows students to have a full health plan at a low cost (at $1,523 per year),” Markus says. “It can be pretty expensive to get a comprehensive plan that gets you all the stuff we offer through the ABOR plan.”

According to ASU student health coverage, students can go to any campus health location at ASU and have access to health and counseling services.

There is also the Bridge Plan, which is a discount health care program for ASU students. This is not health insurance but it can cover the cost of some health expenses, such as a general medical visit, specialist/consultant, basic X-ray and laboratory tests.

From Aug. 16 to Jan. 15, the Bridge Plan costs $96 and from Jan. 16 to Aug. 15 it costs the same. Services range from $10 to $30 with the plan, as compared to up to $200 without the plan. However, his plan only applies to the Tempe, Polytechnic and West campuses according to the ASU student health coverage Web site.

For the Downtown campus, there is the Nurse Care Health Plan program, which is for students without health insurance.

There is a 50 percent discount rate for certain services, but individual students must pay $50 per year. For the first office visit, the cost is $67 with the plan as compared to $135 without the plan. Also, members don’t have to pay for in-house lab tests, such as a urine pregnancy test, strep screen or a routine urinalysis according to the Web site.

Click here for a Q&A with Denise Link, Associate Dean for Clinical Practice and Community Partnerships

Health Care Reform: Proposal

As a new health care bill proposal was introduced Sep. 16 by Senate Finance Committee Chairman Max Baucus, D-Mont., it seems there are more questions than answers.

With the $856 billion 10-year plan, the main question is: Who will pay for it?

The first draft of “Chairman’s Mark: America’s Healthy Future Act of 2009″ is 223 pages long. Fortunately, the New York Times has a PDF version of the proposal.

Although a lot is covered in 223 pages, one of the more controversial issues is revenue. The proposal has to get money from somewhere, and it does this by budget cuts and new taxes.

The proposal states on Page 199 that there will be an “excise tax on insurers if the aggregate value of employer-sponsored health coverage for an employee exceeds a threshold amount.”

There will be a 35 percent excise tax on insurers who offer individual plans of $8,000 and family coverage of $21,000. Basically, the most expensive health insurance plans will be targeted for the tax. Although the insurers are supposed to be taxed, it is assumed that the cost of the tax will trickle down to consumers and raise premium prices for those with the costly insurance plans or possibly even anyone who has a plan with the insurer who offers high-priced plans, according to CNNMoney.

Health Care Reform: What’s  Really Going on?

With all the proposals and new information coming out every day, it’s hard to keep track of what’s actually going on.

Jenessa Cordes, an interdisciplinary studies senior, says she is uncertain about the specifics of the new bill proposal on health care reform but thinks reform does need to happen over time.

“Taking your time would obviously be best…It’s such a huge change,” Cordes says.

As the economy is in a hard spot at the moment, it is unclear whether spending more money on health care would be a good decision — even if the overall amount is less than in the past.

“It would be worse to spend more money now obviously,” Cordes says.

She added that she doesn’t know how spending more on health care would really affect her personally yet.

“Overall, I’m not too worried about it right now,” Cordes says.  ”Again, I’m still a student so I’m not really in the real world yet.”

She says she is currently on her father’s health plan and thinks she will be fine after graduation, since she will be participating in a certified nursing assistant program. She will work in a hospital as a nurse assistant and she will go through nursing school.

“I expect to be under my father’s insurance still,” Cordes says. “I don’t think that’s going to change at all.”

Generally, health care issues need to be explained more, low-income families need to have cheaper (but not free) health care and something needs to be done, she says. “I do know that the health care system is really messed up and it needs to get fixed,” Cordes says. ”Something needs to happen. I’m glad that something is happening now. It may not be the right thing to do, but at least it’s change…because of Obama.”

Hard Times

Tina Drury is a 44-year-old single mother with a bachelor’s degree in psychology from ASU’s New College of Interdisciplinary Arts and Sciences. She is working on entering a graduate school program in the spring, has an 8-year-old daughter and works for ASU West professor Jose Nanez.

Drury also lives off food stamps from the Department of Economic Security, has Mercy Care medical insurance (health insurance for those with little or no income), receives donations for cutting hair, and collects a paycheck for her work as an assistant.

“I did work-study for the first five years of my undergraduate experience but found I could not concentrate on my school so had to drop out of the program for my final year,” Drury says in an e-mail.

She says she returned to school when she was 25 and almost finished her administrative business Associate’s degree when she was hit by a semitrailer.

“…I was hit by a semi in 1993 and ha[d] to teach myself how to read, write, walk [and] talk again with only physical therapy,” Drury says. “At that point I did not think I could go back to college. I could only find workbooks up to the sixth-grade level.”

However, Drury went on to finish two Associate’s degrees and eventually decided to go to ASU with her new-found confidence after she was “actively recruited for leadership roles” at the community college level. Not everyone can suffer a potentially fatal accident and use the experience to come out on top in even better shape academically than before. And Drury even wrote an instructional booklet in dog training in 2002.

“I had scholarships, grants and loans along with work-study to assist me through the undergraduate level,” she says.

From school and work to caring for a child and elderly parents, health care wasn’t an easy option.

“There was a time when I didn’t even have running water, electricity or health insurance,” Drury says.

Other circumstances, such an abusive and unsupportive father for Drury’s child and the downfall of the economy made the situation worse.

“It’s interesting to try and keep a positive attitude in front of your child while you feel like screaming because the stock market crashed and left you penniless…,” Drury says.

She says that her circumstances have helped her learn to use her voice.

“The only thing I can say for certain is that if I don’t speak up, I won’t get heard in any system, whether it be state assistance, educational or even job related,” Drury says. “I would have to say that having my child gave me the strength to do that; speak up, I mean.”

Like many students, especially those who are covered under their parents’ health insuance or who have discounted student rates, Drury says she is not preoccupied with the current health care system.

“Until I see our government trying a health-care system modeled from a country with a higher rating than ours, I don’t think much about it,” Drury says. “I just try to work in the system that exists and will change if our system changes.”

From the Insurance Side

BlueCross BlueShield of Arizona is one of the health insurance companies that graduating students can choose from when considering an individual or group plan. Some employers also offer health insurance from this company, depending on the job a graduated student takes.

“BlueCross BlueShield of Arizona offers individual health insurance, which has a gamut of different options, so there’s a lot of different types of individual health insurance options that have a variety of benefit plans, variety of deductibles [and a] variety of co-insurance payments,” says Andy Wagner, senior communications specialist for BlueCross BlueShield of Arizona.

Wagner says recent graduates or anyone who needs an individual health plan will have to consider many different factors when choosing the right one.

“Not all health plans have the exact same benefit offerings,” he says. “So, for example, we have a health plan that’s very popular with young people that is called the BlueEssential plan.”

Here are some of the need-to-know details of the BlueEssential plan (and others) which could be an option for some graduates, though there are plenty of other insurance plans from other companies to compare:

• Provides coverage for up to six office visits a year with a small co-pay (BlueValue individual plan)
• Office visits include internal medicine, family practice, general practice and pediatrics
• The yearly deductible can range from $250 to $10,000
• Preferred provider organization (PPO)
• Pre-existing conditions have an 11-month waiting period
• Group plan covers dependents up until age 25 who are going to school (other restrictions, like not being married, apply)
• Individual plan covers dependents up until age 30

Although it seems like a lot of money to have to pay before being more fully covered, Wagner says the $10,000 deductible option is perfect for most healthy college graduates who are not covered by their employer.

“The reason someone would choose a $10,000 deductible is because they don’t often use their health plan,” Wagner says. “They don’t have a lot of office visits. They know based on their behavior that if they don’t really need it, what they really want protection from is something catastrophic happening to them, like what would require hospitalization for a week…which would be, in a lot of cases, much more than $10,000.”

The $10,000 deductible BlueEssential plan still allows for the six office visits a year, so accident coverage and a low monthly payment, or premium, is not the only benefit, he says.

Health Care Reform: Medical Personnel

Terry Olbrysh, the director of marketing and communications for the College of Nursing and Health Innovation, says that one of his main concerns in health care reform is the lack of primary care physicians, which can be family doctors, pediatricians and internists, and provide broad and basic care.

“There are shortages which, quite frankly, most people outside of the health care profession haven’t paid a lot of attention to,” Olbrysh says.

He says there are 47 million uninsured people in the United States and an extra 24 million who don’t have adequate insurance.

“If that population were to have access to health care…there aren’t enough primary health care physicians to take care of the increase of those patients,” Olbrysh says.

He said he thinks that if nurse practitioners have full-practice authority, which means they can provide the same services as family care physicians, then there would be an offset to the shortage of  physicians.

“It takes eight to 12 years to educate a physician…for a nurse practitioner, and this is for a doctoral degree too, it takes six to six and a half years,” Olbrysh says.

Depending on the state, nurse practitioners may require physician involvement. For 23 states, physician involvement is not required in diagnosing and treating patients and in 12 states no physician involvement is required in prescribing, according to the Pearson Report from The American Journal for Nurse Practitioners, which was published in Feb. 2008.

Therefore, in certain states the increase of nurse practitioners may not truly offset the primary care physician shortage, since there are too many restrictions currently. Arizona has no requirements for physician involvement in diagnosing, treating or prescribing for nurse practitioners.

Basically, there needs to be reform in this arena, especially by allowing full practice for nurse practitioners in all states and promoting the education of nurse practitioners, physician assistants and primary care physicians.

Contact the reporter at reweaver@asu.edu

Tagged as: graduates, graduating students, health care, health insurance, Obama, Rheyanne Weaver