The early months of 2014 are witnessing the full implementation of the Affordable Care Act and its effort to expand health care coverage throughout the U.S. However, the coverage mandate that the ACA carries is forcing college students to address the question “Am I covered?” and if not, “How am I going to get covered?”
University of Maine student Brittney Marshall faced this question when she turned 21 in February, making her ineligible for the MaineCare insurance policy she had been covered under. This termination of coverage left the third-year marketing student with only one month to find new health insurance before ACA health care exchanges reached the end of their March 31 enrollment period.
Marshall called multiple state agencies and insurance companies to try and understand how she was supposed to gain coverage, but no one could explain to her exactly what her options were.
“I spent most of my spring break, during the weekdays when I wasn’t working, calling around and trying to figure out how this all worked; no one could help me,” Marshall said. “I’m 21 years old. I’m in school there should be something for me.”
Under the ACA, college students have essentially three options for getting covered: the student may remain a dependent on their parent’s insurance policy if they are 26 and under, the student may enroll in their university’s student health plan, or they may enroll in a private plan through the health care exchanges established by the ACA.
“I was doing out the math for every single option, I had it all listed out so I could compare,” Marshall said. “It was just one of those things where I need health insurance; not having it wasn’t an option.”
Remaining under her parents’ insurance plan was not a possibility for Marshall so she turned to the health care exchanges.
In states that chose to expand Medicaid coverage under the ACA, students in Marshall’s position could qualify for Medicaid subsidies that would help pay for health insurance coverage obtained through the exchanges. However, “in Maine, if your income is too low, if you’re under 100 percent of the poverty level, then you’re not eligible for Medicaid because the state has not expanded it yet,” said Amy Fried, professor of political science at the University of Maine.
This is why when Marshall sought insurance coverage through the health care exchanges she could only qualify for plans that had monthly premiums of upwards of $300 per month, substantially more than she could afford to pay out of pocket.
“Because LePage did not pass Medicaid expansion you actually have to make a minimum of $11,490 per year to get any assistance, and I was only putting in [$10,000],” Marshall said.
After voicing her struggle for coverage to a friend who works at a doctor’s office, the friend put Marshall in touch with the office’s health care liaison who explained to Marshall what her options for coverage were.
Because Marshall’s yearly income was close to the $11,490 minimum for tax-credit assistance, the liaison advised her to enroll in a Maine Community Health Options plan available on the healthcare exchange and try to increase her yearly income for 2014 to the assistance minimum.
“Which just means now I am going to have to work more,” said Marshall, who balances working part-time at JCPenney while maintaining a full-time student status.
Through this coverage route, Marshall’s monthly premium will be about $37. If Marshall fails to make the minimum income she will owe the state however much she received in the tax credits that helped to subsidize her health care costs.
University of Maine political science professor Mark Brewer explains this type of confusion is to be expected with large new federal legislation.
“[The ACA] is all so new that a lot of it is figuring it out as we go along, as is often to case with any major policy change,” Brewer said.
Aside from the ACA’s infancy, the complexity of the Act is also making it less user-friendly than desired.
“It’s a complicated law because there are multiple ways people can get health care, its not something where if everybody was covered with the same thing it would be much easier to understand,” Fried said.
Instead of a “universal health care” system that would seek to streamline all health care options through a public governmental system, the ACA sought to increase the access individuals had to both public and private insurance programs.
”There are people getting [insurance] through their employer, there are elderly people getting [insurance] through Medicare, there are people getting veteran’s insurance, and then if you’re talking about everybody else they can get private insurance plans through the insurance exchange,” Fried said.
The University of Maine also offers undergraduates with 9 or more credits and graduate students with 6 or more credits access to a student health insurance plan that, for the 2013-2014 school year costs about $2,900 annually.
“I looked into the school plan it and it was way, way more than I would have had to pay even with the health insurance plans that were not giving me any tax credits on the marketplace,” Marshall said.
The University of Maine System is implementing a new policy for the 2014-2015 school year that would require students to provide proof upon enrollment of adequate health care coverage.
This change in policy is due in part to the ACA coverage mandate, as well as a resolution that was passed by GSS last year which called for the university to restructure its expensive student health plan.
After March 31, uncovered individual are subject to a federal “tax” if they do not have health insurance coverage in line with the minimum requirements of the ACA.
The “tax” for the lowest income level, which most students would fall in is $95 for a year without coverage.
Marshall said that if not having health insurance was an option for her personally she would have just paid the $95 dollar fine and gone without coverage.
“The cheapest option would be paying the fine, but that might not be the smartest option,” Brewer said. “When you look at some of the activities [college students] engage in, they’re far more likely to take risks, they’re far more likely to engage in recreational activities that are more likely to result in injury. If you have one bad injury and no coverage, not even a catastrophic plan, that could be a serious problem.”