President Clinton's attempted health reform 16 years ago included efforts to address college health services. As President Obama now tackles health care, it is an opportune time to review the state of college and university health programs and the effects of reform on them and their future. The bottom line: if college health programs are to survive, market forces and regulation will require a change from the current strategy of managed care avoidance, increased fees, limited service, and expensive programs. College and university planners must take stock and adapt to a changing health care environment if they are to fulfill the needs of their students and their institutions.
The Historical Context
In 1993, during the height of the Clinton health care reform debate, college and university health programs were at a crossroads. Campus health center funding was being cut significantly, with a decrease in overall institutional support from 45 percent to 16 percent between 1987 and 1990. Student fees were raised in response, with revenues almost doubling from 34 percent to 63 percent of the health services budget during this same period (Brindis and Reyes 1997).
Predictably, students and their families demanded change. In fact, a Journal of American College Health article (Brindis and Reyes 1997, 11 41) asked how college health programs could continue this strategy when "students and families argue that, because they already have HMO coverage or some other insurance plan, they should not have to pay for a second, college health fee" Parental frustrations grew further when they recognized they were actually paying three times--to keep their child on their insurance, for the health fee, and for additional expenses such as laboratory tests uncovered by campus plans (Liang, forthcoming). The article's authors argued that "billing the managed care program for services might be more manageable and cost effective," while the argument against billing insurers was typically based on administrative concerns (Brindis and Reyes 1997, [paragraph] 47).
In his reform efforts, President Clinton considered this same concept. With the growing importance of managed care came a proposal to provide employers with incentives to pay a combined student insurance plan/health services fee directly to school health plans to cover student beneficiary health needs.
Although this integration of managed care into college and university health programs was innovative, it failed when the Clinton plan failed. Ever since, managed care has grown exponentially; the integration of it into student health programs seems logical if not inevitable.
The Reform Context
Yet today, only a minority of campuses have found a way to do this, despite a U.S. Government Accountability Office (2008) report noting that two-thirds to three-quarters of students carry insurance either through a parent's employer-sponsored managed care plan or on their own. Managed care is here to stay, and nearly everyone in the United States uses it. However, the status quo of 1993 still exists on campus--parents and students continue to pay up to three times for campus health care. To add insult to injury, those who refuse school-based insurance may pay up to five times the amount for services on campus compared with those who enroll in the school plan (Liang, forthcoming). Further, the GAO report found that school-based plans have low coverage ceilings, have "interior" caps for particular sets of services that further reduce coverage, and simply offer little for the money compared with similarly-situated managed care plans available in the community.
So while President Clinton's reforms--albeit unsuccessfully--attempted to address college and university health, what do President Obama's reform efforts do? At one level--perhaps most compelling--students could remain on their parent's health insurance plan until age 27. …