Saturday, January 23, 2010

What Compulsory Coverage Really Means

A little over a week ago I wrote a compelling (in my humble opinion) reminder to this state's leaders that while they are attempting to block any federal proposal of health care reform that would include compulsory health insurance among its citizenry, they should remember that there is a significant population of Idahoans that are subject to compulsory health insurance already.

In my post, I reminded the state's Republican leaders, because let's be honest the anti-reform sentiment is not originating in the Democratic Party, that full-time university and college students across the state are required to hold health insurance prior to enrolling in classes. How many Idahoans does this effect directly? Fall 2009 full time enrollment provided by the State Board of Education say 49,279 full-time students are enrolled in Idaho universities and colleges. This number includes students at University of Idaho, Boise State University, Idaho State University, Lewis Clark State College, College of Southern Idaho, College of Western Idaho, Eastern Idaho Technical College, medical students in the WAMI program, and dentistry students enrolled in IDEP. 49,279 students is approximately 3% of Idaho's population (as of 2008).

Now, I can't speak for 49,278 of those students, but I can speak for me. What I didn't mention in my previous post is that the SBOE policy that requires full-time students carry health insurance has been a godsend for me. Because state law requires students carry health insurance if enrolled, each individual school is able to contract with an insurer that will cover any student, regardless of health status, age, sex, and/or economic status. Each student pays the same premium, the same deductible, and the same co-pays. With the exception of fall semester 2009, I have been covered by the student health insurance plan since the fall semester of 2003 an had the policy not existed that allowed me to be covered through Idaho State University, I wouldn't have been covered under any other policy all this time.

You might ask yourself why it matters that someone my age (25 in May) be covered at all. I assure you, many of my peers ask themselves this question often and many of them go without health insurance. I have friends of a similar age that do not have health insurance, either because they are not students, cannot afford it on their own, or are not eligible for Medicaid. I also have friends who are not on Medicaid because they are too proud and consider it personally unacceptable to apply. Many of my friends have lived uninsured and never had a problem. Sure they would like to go to a doctor, sure they would like to have coverage for things like dentist visits, eye exams, and simple medical checkups, but they've lived without these things and largely without incident. I am not in that boat.

To illustrate my point about the student health insurance program being a godsend, I hope you might consider that not all young adults like myself are as blessed my genetics and good health. I am certainly not one of them. The first semester I was in college, my student health insurance wasn't something I spent much time considering. I thought it odd that college students, who are generally healthy because of our age, were required to carry health insurance. Many of my classmates were able to waive the student insurance because they were still on their family's policy. I was not and paid the semester premium. When did I begin to realize how essential the student insurance plan is? December 28, 2003. Yes, an exact date. Why? I was in a car accident that day. As snow was dumping on Pocatello, I had the brilliant idea that I needed a snow shovel and out I ventured into the storm. Living on the south end of Pocatello, I got on the interstate and headed toward Chubbuck. Driving a bit faster than I should have been for the conditions, I panicked when a car in front of me put on their breaks to avoid ice. In my panic, I hit my breaks and lost control of my car. I crossed the two north bound lanes of the interstate, flew across the median, crossed the two south bound lanes and screeched to a halt as my car hit a guardrail head on. Had the guard rail not been there, I would have continued on down the hill to Terry Street. I was rushed in an ambulance to the hospital, I had broken ribs, a bruised forehead, an abrasion across my chest from the seat belt I was thankfully wearing, and a totaled car. When January rolled around and I went to pay my tuition, I didn't think twice about the student health insurance premium.

My reliance on the student insurance plan has continued to be crucial. Over the years I have had many treatments and procedures for a long-term health condition. I have benefited greatly from the discounted rates the student health center offers for prescription drugs, medication I will also be taking for the rest of my life. And over the past two years, carrying health insurance has been just as critical as it was for me in the winter of 2003.

As those of you who read this blog regularly know and as I recounted in my post about the public option, in February of 2008, I awoke in a hotel room in Boise after the Frank Church Banquet with stiffness in my low back and the inability to get vertical. After the drive home that Sunday, my back was wrecked. By Easter I had lost feeling in portions of my left leg. In May when visiting with the physician assistant at the student health center here on campus, I mentioned that I was having trouble riding my bicycle because of some numbness in my leg and tightness in my hamstring. The following week I had an MRI and was diagnosed with a protruding disc in my back that would eventually require surgery. The surgery itself was a success because it restored feeling to my left leg, but during the surgery I was positioned on a nerve that caused damage and continues to give me hell today. I remain beholden to an aggressive physical therapy program for pain management and am still learning how to use muscles correctly. It has been a nightmare that only those who suffer from chronic pain can fully understand.

The costs of the surgery, the four MRIs, the medications, the treatments, and the physical therapy have been astronomical. With the exception of this past semester when I wasn't a student, the student insurance plan has covered nearly all of the costs of physical therapy and a substantial amount of the rest.

Something the student insurance plan doesn't cover per se is vision (also dental). When I know that I need new glasses or contacts, I pay for that out of my pocket. Since sitting still has been problematic since back surgery and because I didn't want to admit to my eye doctor that I'd gained quite a bit of weight both before and after surgery that I can't seem to lose now that I'm fairly immobile, I hadn't been to the eye doctor since February 2008. I have been experiencing headaches daily for some time and a ringing in my left ear that I'd chalked up to side effects from the pain meds and muscle relaxers I take daily. Monday I went to the eye doctor and immediately he sent me to an eye specialist. The eye specialist saw the same problem involving my optic nerve and ordered an MRI that I had Wednesday. Tuesday I will be having a spinal tap. Should this problem have gone on without me seeking medical care, my vision would have continued to decrease, a loss that would be permanent.

Had I not enrolled this semester in school, there is no possible way I would have been able to afford this week alone. And had I not had insurance, I'm fairly sure some of the tests that have been done this week would not have happened at all. Last semester I'd taken time off of school hoping the time off would allow me to concentrate my energy on physical therapy and getting healthy. I was put on a Blue Cross policy that refused to pay for my claims and I ended up paying for a semester's worth of physical therapy out of pocket. School started on the 11th and by the 18th I had a significant medical diagnoses and emergency health situation that required immediate care. Without being overly dramatic, I think it is safe to say that if I hadn't saved the money to see my eye doctor and then been on insurance to cover the MRI and extensive tests, vision loss would have been imminent.

The truth of the matter is this: I enrolled in school this semester because I needed insurance desperately. Do I need to take classes? Not at a school where I have no future and no hope for another degree. However, I did what I had to do and I am extremely glad I did.

While our Republican legislators and governor carry on about how unconstitutional it is to force citizens to have health insurance, they refuse to acknowledge that they have, since 2003, required it of a certain demographic of the population. Did they target college students because it is a demographic that rarely votes? Probably not. Did they create the policy because it was costing the state and its institutions of higher learning too much money and grief to have uninsured students? Probably so. I truly believe, as does the majority party in Congress, that mandating coverage will save both federal and state government money. It limits the stress on county indigent services and the state's catastrophic health fund. I am not convinced that current attempts at the federal level to reform the health care system do anything to help those of us who would be impacted by a mandate to carry insurance and simply can't afford personal policies on our own, but this is beyond the scope of what Republicans in this state are angry about.

Clearly, state leaders would rather put up roadblocks based on some ideological belief that Congress is violating the U.S. Constitution than actually discuss how their own compulsory insurance policy in this state has helped, even saved, young Idahoans like myself.

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