Fear of absorbing health insurance costs hit San Diego’s youth

Health care reform remains a hotly debated issue. It makes sense. The U.S. Census Bureau reported 46.3 million people had no health insurance in 2008.

Still, the debate has failed to highlight a key group: young people even though the health care package will affect them just as much. The issue is more so prominent in college town, San Diego.

In 2008, people age 18 to 24 had the highest rate of no health coverage at 28.6 percent, according to data compiled by the U.S. Census Bureau. The second highest uninsured group included people 25 to 34 years old at 26.5 percent. Thus, young people constitute more than half of all uninsured people in the U.S., according to the report.

If the proposed health care reform is passed, college students would be greatly impacted and in multiple ways.

First off, the millions of people who are uninsured, which includes college students, would have to obtain insurance, said San Diego State University political science professor Brian Adams.

In fact, he said this is one of the positive aspects of the legislation.

“Young people should probably get insurance anyway, because even if you’re healthy you can get into a car accident or you can have some catastrophic illness,” he said. “If you get into a car accident and you have $200,000 of health care debt, it can bury you for decades.”

SDSU journalism and media studies senior Natalie Scott is thankful to have health insurance through her parents’ plan while she is in school. She is concerned, however, about being covered once she graduates.

“I want to be covered even when I’m done with college and have my first real life job,” she said. “I won’t be getting paid too much so it is important to me that I get coverage and can afford it while I am working on my career.”

Other students, like Mary Zhong, have no health insurance. Her health care was terminated under her parents’ health plan when she recently turned 20. Zhong, who is a political science major, said she is “immensely” concerned about health care and hopes to purchase coverage through her part-time job.

“I recently studied abroad in Oxford University in England and was in awe of their universal health care system,” she said. “The U.S. is a highly industrialized nation, and yet I find it baffling that we are without some form of universal medical access. Everyone needs health care, and it should be easy to access.”

New Rules Promise Better Mental Health Coverage

WASHINGTON — The Obama administration issued new rules on Friday that promise to improve insurance coverage of mental health care for more than 140 million people insured through their jobs.

In general, under the rules, employers and group health plans cannot provide less coverage for mental health care than for the treatment of physical conditions like cancer and heart disease.

Insurers cannot set higher co-payments and deductibles or stricter limits on treatment for mental illness and addiction disorders. Nor can they establish separate deductibles for mental health care and for the treatment of physical illnesses.

Such disparities are common in the insurance industry. By sweeping away such restrictions, doctors said, the rules will make it easier for people to obtain treatment for a wide range of conditions, including depression, autism, schizophrenia, eating disorders and alcohol and drug abuse.

For decades, many health plans have had limits on hospital inpatient days and outpatient visits for mental health treatments, but not for other types of care.

Kathleen Sebelius, the secretary of health and human services, said the rules guaranteed that people with debilitating mental disorders would not suffer “needless or arbitrary limits on their care.”

The rules, which take effect on July 1, carry out a 2008 law that was adopted with bipartisan support. They significantly expand the rights of people with mental illness, much of which goes untreated because of insurance restrictions.

Under the rules, insurers can still review claims for “medical necessity,” can still require prior approval of some services and can still charge consumers more for using doctors and hospitals that are not on a list of preferred providers.

But under the rules, insurers cannot use these techniques in a more restrictive way for mental health care than for other medical services.

The administration said the new requirements could increase premiums by four-tenths of 1 percent, or $25.6 billion over 10 years. Businesses with 50 or fewer employees are exempt.

The rules apply to group health insurance plans of the kind typically offered by employers. Federal health officials said the rules did not apply to the individual insurance market, where policies are sold directly to individuals and families. However, some states have laws that apply to the individual market.

Irvin L. Muszynski, a lawyer at the American Psychiatric Association, praised the government’s decision to require a single deductible for mental health and medical-surgical coverage.

“Patients with mental illness often have general medical conditions like diabetes or high blood pressure that require treatment at the same time,” so a combined deductible makes sense, Mr. Muszynski said.

The rules were developed by the Labor Department, the Department of Health and Human Services and the Internal Revenue Service, which share responsibility for their enforcement.

The government said the rules would benefit 111 million people in 446,400 group health plans offered by private employers, and 29 million people in 20,000 plans sponsored by state and local governments.

In the new rules, the government says a health plan would be violating the law if it “imposes an annual $250 deductible on all medical-surgical benefits and a separate annual $250 deductible on all mental health and substance-use disorder benefits.”

The rules say that an insurer may require “prior approval that a course of treatment is medically necessary.” But the insurer cannot enforce this requirement in different ways for medical benefits and mental health services. For patients who receive treatment without prior approval, the penalty must be the same.

A number of companies specialize in managing mental health benefits. The Obama administration said the techniques used by these companies would hold down the cost of complying with the new rules.

But, it said, the standards and techniques used to manage mental health benefits must be comparable to those for other medical care and cannot be applied more stringently.

In a preamble to the rules, the Obama administration said that patients had typically faced higher co-payments for visiting mental health professionals than for visiting primary care physicians.

The rules are likely to reduce this disparity, so more people will be treated by mental health professionals, the administration said. This, in turn, “could lead to more appropriate care and thus better health outcomes,” it said.

The law requiring parity in the coverage of mental and physical illnesses is named for its sponsors, former Senators Paul Wellstone, Democrat of Minnesota, and Pete V. Domenici, Republican of New Mexico.

What About Health Care Reform?

President Obama mishandled the important topic of health care reform during his State of the Union speech on Wednesday night.

He spent little time discussing the issue, but when he did, he showed no sign of changing his method or learning from his opponents, insisting once again, "Our approach would preserve the right of Americans who have insurance to keep their doctor and their plan." But where is the evidence of this? Both major bills before Congress include clauses which dictate exactly the kind of insurance you can have and what you can't.
And where is the incentive for doctors to keep accepting this insurance? More than 50% of practicing doctors already don't accept Medicaid, according to a 2005 survey, and the Medicare Payment Advisory Commission determined in 2008 that 28% of Medicare patients were unable to find primary care doctors. The yearly doctor dropout rate in private insurance exceeds 10% in many places, including New York.

President Obama went on to state that the health reforms would "reduce costs and premiums for millions of families and businesses," but how so? In Massachusetts, for example, insurance premiums went up when companies were compelled to cover pre-existing conditions and not drop anyone when they were sick. Noble ideals, but costly. And the rate of unnecessary ER admissions has remained steady at 15% even after universal health coverage passed in the bay state. "Patients will be denied the care they need" if health reform doesn't pass, the president reiterated last night, but there is no proof that increasing coverage expands access to health care. In Canada and Europe, the opposite is true.

The American public is no longer accepting the same tired platitudes, as evidenced by the Massachusetts election and the current climate around the country.

There are crucial problems not being addressed by health reform: First, there is a big shortage of doctors throughout the country, which will interfere with access to health care no matter your insurance coverage. The Association of American Medical Colleges estimates a shortage of 150,000 doctors by 2025.

Second, a one-size-fits-all HMO-style insurance is expensive and easily overused. It lacks the built-in disincentive for overuse of cheaper, higher-deductible insurance. Extending low-deductible insurance (a central principle of all the health reform bills) will lead to higher premiums, especially without portability to promote competition.

Third, even if you already have insurance it will be choked by government regulations and oversight under the new health insurance system, and it isn't likely to cover the high tech solutions you need. Lastly, doctors are already overwhelmed with too many patients. With no tort reform and decreasing reimbursements, they are likely to quit or at least quit taking insurance.

By not acknowledging America's concerns about health reform Wednesday night, the president appeared inflexible and incapable of real compromise. And by not spending much time on a topic that was front and center just a few weeks ago, he looked more like a politician than a leader.

Marc Siegel, MD