Young, healthy people are the targets, crucial to the success of the nation’s new federal health care law. They rarely see a doctor and would pay premiums for years to come. Their money would help cover the care of older and sicker customers.
And one of the largest experiments to educate and ultimately enroll them is underway in California.
California State University, with more than 437,000 students across 23 campuses, is applying a $1.25 million federal grant to reach students, their families, part-time staff and even those who apply to universities but don’t enroll. Plying them with pizza and luring them with hip-hop, campus leaders and student ambassadors are dangling subsidies for signing up and warning that even a simple sports injury could spell financial ruin.
They are talking to people like Martina Rose Rocks, who was scurrying across campus on a recent afternoon when she came upon multicolored tents outfitted with flat-screen televisions. A DJ spun records, fitted in an oversized sweatshirt bearing a portrait of President Barack Obama.
Rocks, a full-time student at Chico State University, is without health coverage, so the pitch she would get from a volunteer with the state insurance marketplace caught her attention. Especially attractive was paying as little as $5 a month after receiving a federal subsidy based on her age, income and residence, she said.
Rocks, 32, said she plans to sign up for a plan after doing more research. She hopes to have coverage as soon as the first of the year.
“It’s really scary not to have health insurance,” she said.
While they may not use much health care, costs for students tend to be extremely low because they qualify for sizable subsidies, said Peter V. Lee, executive director of Covered California, the state’s health care exchange.“So they have huge rationale,” he said.
The man selected to lead the system’s outreach campaign is Dr. Walter Zelman, chair of the Department of Health Science at California State University, Los Angeles. Zelman has spent decades working on health policy, including with Insurance Commissioner John Garamendi in the early 1990s when he helped develop a universal coverage plan that became a model for plans proposed by the Clinton administration.
Two years ago, he was working at CSU with interns whose project involved contacting the state exchange and urging officials to give special attention to students because of the high numbers of uninsured.
“The thought behind this was obvious,” Zelman said in an interview. “We have a huge population of CSU students and families that are largely middle and lower income, young and disproportionately Latino. Anyone who studies uninsured or underinsured or those with health risks knows these groups come to mind.”
While University of California students must have health coverage, CSUs do not require insurance as a condition of enrollment. Zelman estimates about 30 percent of CSU students are uninsured, give or take 10 percent based on the region of the state.
“These are responsible, hardworking students who are trying to improve their lots in life and to help their families,” he said. “Many in increasing numbers want to go to graduate school, they want to give something to society, and yet they are uninsured.”
Critics decry ‘bill of goods’
The outreach group is doing a range of activities, from sending emails and setting up tables to partnering with student government and clubs. But the most effective method has been traditional, five-minute classroom presentations.
A series of open forums are set for the coming days, and officials are already talking about serving as a model for schools outside the system. CSU’s grant is set to expire March 31 after reaching a quarter-million people, although organizers believe they can educate four times the goal.
Lara Falkenstein, an outreach coordinator at California State University, Sacramento, said her talks generally include a line about the health law requiring most people to obtain insurance or pay a penalty. She shows them nearly a dozen “essential health benefits” available under state exchange plans and demonstrates what care for an injury, say a broken wrist, could cost without insurance.
Another tactic organizers say satisfies young adults’ anxieties over the possible cost of coverage is an iPad app that estimates monthly premiums based in part on how much a student wants to pay out of pocket.
In Los Angeles, Zelman said organizers began offering pamphlets demonstrating several scenarios: A 23-year-old individual making $15,000 annually would be eligible for Medi-Cal. A 21-year-old earning $18,000 annually would have a monthly premium of $191 minus $140 in assistance, bringing the monthly total to $51. A family of four, aged 45, 43, 21 and 19, with an income of $40,000 a year, would be on the hook for a monthly premium of $847 minus $744 in assistance, leaving them to pay $103. The sample plan would pay at least 80 percent of health costs, including co-payments and deductibles.
California officials said they have not encountered groups on campus offering a countermessage. Nationally, Generation Opportunity has been creating online videos and disseminating kits that urge students to opt out of the federal and state exchanges. The Virginia-based outfit with ties to conservative donors is touring college campuses to serve as a counterweight to outreach organizations such as Enroll America.
“Young people are being sold a bill of goods and there’s millions, if not billions, of dollars behind selling them that terrible deal,” Generation Opportunity President Evan Feinberg said. “It’s our goal to empower and educate them to make a better decision than to opt into these awful health care exchanges.”
Feinberg called it shameful that taxpayer funds were going to selling young people something that’s not in their best interest. He objected to a system that uses the young and healthy to subsidize the health care of an older, sicker generation.
In cases where students could benefit from a subsidy and possibly pay less, he said: “It’s still a creepy and intrusive federal government that is going to have control over your health care decisions. They are going to get all kinds of data on you through this massive federal data hub that’s not secure,” Feinberg added.
‘Young, not stupid’
Outside Trinity Hall at Chico State, Brian Kaplun, a 29-year-old studying criminal justice, said he was eager to learn more about how to get coverage for himself. Blong Vang, 26, who is studying health administration, wants to help his siblings get covered.
Sarah Eggert, 21, of Lincoln, said obtaining health insurance could prove to be a lifesaver. A biology major who works part time in fast food, Eggert said even if she was accepted, she could not have afforded a standard insurance plan under the current system because of her family’s medical history. Her mother and four siblings all were diagnosed with breast cancer at a young age.
“The doctor told me it’s not a question of if, but when,” she said.
Eggert acknowledged she should be more diligent about screenings and is excited at the thought of free or low-cost preventive care under the insurance overhaul.
For now, she and others at CSUs continue to receive basic care on campus through health centers. Dr. Deborah Stewart, the medical chief of staff at Chico State University’s Student Health Center, said she sees 30,000 students a year. What many are not aware of is that the only time they are covered by student fees is during regular business hours on weekdays. “All other times they need to see a doctor or nurse their student fees don’t cover,” she said.
Lee, the state exchange chief, likes to refer to college-age customers as “young, but not stupid.” Zelman said his experience with young adults has caused him to mostly reject the term “young invincibles,” to describe young people who spend little on health care in part because they believe they don’t need coverage.
“They are not irresponsible. They don’t want to roll the dice with their health,” he said. “They just in most cases cannot afford to do anything else.”