Young, invincible, not particularly wealthy college students are prime candidates for health insurance under the Affordable Care Act. Many qualify for government subsidies or Medicaid, and most are healthy, representing a vitally important portion of the insurance pool. Without them, the clientele covered by state and federal exchanges would be older, less healthy and more expensive.
A recruiting project at the California State University system — billed as the nation’s largest and possibly most diverse college system — has shown promising results and could be used as a model for other university systems, according to organizers.
“The main goal is to help students and their families get coverage and I think we’re succeeding,” said Walter Zelman, director of the CSU Health Insurance Education Project and chair of CSU-Los Angeles’ Department of Public Health.
“But one of my hopes in doing this is to serve as a model. I’m hopeful that other university systems can recognize the potential and do something similar,” Zelman said.Good Statistics in Project’s Freshman Year
Funded with a grant from Covered California, the project’s goal was to get coverage for as many of the 450,000 students at the system’s 23 campuses as possible. Using a peer-to-peer classroom process at the largest 15 campuses, student coordinators made more than 1,500 classroom presentations, organized more than 60 forums and staged some 300 enrollment events. The project was timed in conjunction with Covered California’s first open enrollment period.
Before the project, the number of uninsured students on the 15 targeted campuses ranged from about 25% to 30%. The average estimate now is about 10%. The percentage of uninsured Latino students — estimated at more than 40% before the project — dropped to 13%.
The CSU system was a good place to launch such an effort, Zelman said.
“If there is a population that’s ripe for coverage under the Affordable Care Act and for state and federal exchanges, this is it,” Zelman said. “Young people, many low income, intelligent, computer savvy. The vast majority of students want to have coverage and when they find it is affordable with subsidies, they sign up,” Zelman said.
Zelman said the state college system, which serves more low-income and minority students than the University of California system, was fertile recruiting ground.
Unlike the University of California system that requires students to show health insurance coverage before starting classes at one of the 10 UC campuses, the CSU system does not require coverage.
“There has been talk about moving in that direction — requiring students to be covered,” Zelman said. “But now, with the Affordable Care Act requiring coverage, that changes the equation.”
The project’s success may generate interest from other state university systems, said Gerald Kominski, director of the UCLA Center for Health Policy Research and professor of health policy and management.
“There are certainly important lessons to be learned. Any state that is serious about reducing the rate of uninsured young adults could benefit from the lessons of Zelman’s work. Walter’s study shows that targeted outreach can be a highly effective way of increasing coverage.”
Kominski said college systems in states without expanded Medicaid or a state-run exchange might face different challenges.
“The success of programs in other states could be tempered by a different climate. College systems in some of the larger southern states might find the going more difficult because they’re not expanding their Medicaid programs,” Kominski said.
“That’s not to say university officials shouldn’t make the effort,” Kominski added. “Clearly this kind of project can help both the individual students who get coverage as well as the overall system that benefits from a larger pool.”
Zelman said many states could benefit from recruiting college students and their families, regardless if the state has expanded Medicaid.
“State public systems that cater to [low]-income and minority students have something to gain by making sure students and their families are educated about the possibilities under the Affordable Care Act,” Zelman said.
“Even if a state is not doing the Medicaid expansion, there are still a sizeable number of options — subsidies in exchanges, existing Medicaid and low-cost coverage. The subsidies for low-income people are so significant education efforts are very important.”
Zelman said the CSU project resulted in many family members of students getting coverage, not just students.
“When we did our polling at end of the last open enrollment, we found that a lot of parents enrolled partly because of students being exposed to the possibilities through this project. That should be another encouraging reason for other systems to try this,” Zelman said. “We do hope other states will see this and move in this direction.”