Health Care and Higher Ed

WASHINGTON -- Though higher education has been discussed in the legislative debate here almost exclusively in the context of the student loan reforms that have been attached to a budget bill, colleges and universities have not been forgotten in the health care measure that President Obama is planning to sign into law today.

The broader implications for institutions of higher education -- as employers, gathering places for thousands of people, and part of the U.S. economy -- are unclear and depend in large part on whether they’re being described by a Democrat or a Republican.

But there are several tangible ways in which the legislation will benefit students, campus health centers and medical schools more immediately.

College- and university-based student health insurance plans are given a special exemption to continue to exist, even though they don’t fit classification as individual plans or employer-based group plans.

Jim Turner, president of the American College Health Association and director of student health at the University of Virginia, said that, “in the end, the bill that passed … includes ACHA’s original intention. Our advocacy to make sure that colleges and universities can still offer health insurance plans appears to be intact and we’re very pleased by that.”

Drafts of the bill considered by the Senate Finance Committee and the House of Representatives last fall did not include any specific language on the student plans, alarming Turner and others.

After Inside Higher Ed reported on the omission in October, Turner and others from ACHA were able to meet with Finance Committee staffers who explained that the omission was inadvertent and “there had never been any intent to interrupt student health insurance,” he said. That committee’s draft language, in turn, was revised to produce the final bill that was passed by the Senate in December and the House on Sunday night, and that will be signed by the president today.

For a few weeks in January, it appeared that the exemption for student insurance plans might be at risk, prompting the ACHA and the American Council on Education to urge lawmakers to include the provision in the compromise health care legislation they were drafting at the time. But because the health bill passed by the House on Sunday night reverted to the Senate version of the bill that included those provisions, those concerns became moot.

Student insurance plans were offered at 71 percent of four-year independent nonprofit colleges, 82 percent of four-year public institutions and 29 percent of two-year publics during the 2007-8 academic year, the Government Accountability Office reported in March 2008. With the rise of health insurance mandates at some institutions and systems, it is likely those totals have gone higher.

Another potential windfall for higher education is for students whose campuses don’t offer health plans or who opt not to buy them. As of late September, young adults will be eligible to be covered by their parents’ insurance plans through age 26. For undergraduate and graduate students who would otherwise have aged off their parents’ plans, it’s “one less thing to worry about as they try to make their way through school,” said Ari A. Matusiak, cofounder of Young Invincibles, which represents young adults who favor health care reform.

For recent graduates who may be unemployed, freelancing or otherwise unable to get insurance policies of their own, the bill's provisions are likely to be a major boon. “This is a huge step forward," Matusiak said, "for millions of young people who have historically, until now, had to worry about where to get coverage as they start their careers,” and might have opted to take jobs they didn’t want, paid high premiums for individual or COBRA health plans, or gone uninsured. Now, at least for those whose parents are insured, there’s the option to stay on that plan.

Employer-based plans are in many instances more robust than campus-based plans, said Larry McNeely, health care reform advocate for U.S. Public Interest Research Group. “Students will be able to just link into their parents’ health plan, oftentimes with much superior benefits.”

McNeely said he also sees potential benefits down the line for colleges and universities as employers. If, as the Business Roundtable has estimated, employers are able to save as much as $3,000 per employee by 2019, there’s the potential that “it would mean more money for financial aid and faculty salaries and all the other things that matter.”

Changes in the way the U.S. health care system operates and health care providers are compensated will probably cause major shifts in medical education and training. Allopathic and osteopathic medical schools are on longstanding campaigns to expand their enrollments and, said Christiane Mitchell, director of federal affairs for the Association of American Medical Colleges, “there will be an even greater demand for doctors."

In a statement, the association's president, Darrell G. Kirch, said U.S. "medical schools and teaching hospitals have expressed their full support for this bill to President Obama, and now stand ready to work with the administration and Congress to implement these significant changes to our health care delivery system."

The bill also includes what Mitchell called a “significant expansion” (though she couldn’t pin down a dollar amount) of funding for the National Health Service Corps, which helps fund young doctors who work in underserved areas, and the Title VII Health Professions Education program, which offers scholarships and loan forgiveness to help diversify allied health professions racially, ethnically and geographically.

One concern, though, is that the bill does nothing to expand Medicare support for graduate medical education. There is a cap on the number of residency positions available for medical school graduates that the AAMC and other groups consider insufficient to serve the workforce needs of the future, especially with an even larger number of insured Americans. “We’ve been urging Congress to eliminate the caps, to allow us to increase our residency training programs,” she said, “but they didn’t.”

Steve Shannon, president of the American Association of Colleges of Osteopathic Medicine, is also concerned about the cap. Though the bill allows for “some more flexibility -- unused slots can be reallocated, [the bill] preserves spots that would be eliminated when a hospital closes” -- it doesn't do enough, he said. “Graduate medical education needs to be addressed and expanded in a way it isn’t here.”

He added that the bill’s passage and signing is “kind of the beginning of a process” that will continue with new developments at institutions, more legislation and regulations coming from the Departments of Education and Health and Human Services.

But it’s also the beginning of the backlash. The conservative blogosphere has begun to hum with concerns that the bill’s provisions for funding medical education programs favor “entities that have a demonstrated record of ... training individuals who are from underrepresented minority groups or disadvantaged backgrounds,” as the statute puts it.

Virginia’s Liberty University, founded by the late Rev. Jerry Falwell, took the lead in general opposition to the health care legislation Monday, announcing it would file a lawsuit questioning the constitutionality of Congress’s actions as soon as the bill is signed by the president.