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Graduate students continue push for affordable dependent healthcare

‘Not today,’ Brubaker-Cole said on request for commitment to affordable dependent coverage

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After Vice Provost for Graduate Education Stacey Bent, Vice Provost for Student Affairs Susie Brubaker-Cole and Associate Director of Vaden Health Center Leigh Stacey agreed to meet with a small group of graduate students to discuss rising dependent healthcare costs on Friday, they came face-to-face with a crowd of protesters pressing the same issue. 

Upon stepping outside, the three were confronted with a peaceful demonstration of about 100 graduate students and their spouses. Some also brought their young children. Attendees wore all black and marched from Stanford’s Main Quad to Bent’s office.

The protest followed months of collecting over 1,000 signatures on an online petition, which asks Stanford to make dependent care free for graduate students’ children and spouses who are not covered by their employers. Dependents — including spouses, younger children and children with disabilities — must be related to a currently enrolled Stanford student covered by Cardinal Care to be eligible. The dependent plan does cover pre-existing conditions.

Protesters held signs that read “Stanford, don’t discard dependents,” “noncitizens deserve healthcare,” “don’t price us out of grad school” and “don’t be evil.” They also carried a large banner with the statement “Stanford, our dependents deserve more than band-aid solutions,” on which they stuck 1,000 band-aids to represent the petition’s signatures.

The petition’s text additionally points to the recent closing of two on-campus childcare centers, which offered graduate students priority enrollment and reduced tuition, and the high costs of childcare in Palo Alto as contributing factors to the affordability issue.

Two toddlers — both children of current Stanford graduate students — hand-delivered the petition to administrators upon the protest’s conclusion. The students are requesting that Stanford create a $50 million endowment to fund the healthcare plan.

“Stanford’s endowment is on the order of $28 billion,” said graduate student Irán Román, an SSN member and petition co-author. “So $50 million is almost nothing to solve a big issue.”

The petition was launched last spring by members of the Stanford Solidarity Network (SSN), an activist group of undergraduate students, graduate students and Stanford staff, according to Justine Modica, a history graduate student and SSN member who co-authored the petition.

While they did not directly comment on a specific remedy, Brubaker-Cole and Bent wrote that “Stanford cares deeply about the well-being of families of students, and we seek to work with students to find solutions that meet needs,” in an email to The Daily. 

They continued, “We recognize that dependent insurance costs remain high, reflecting the high cost of medical care in our region. As we explore measures to address this, we are encouraged by the work of the Affordability Task Force, which has organized its efforts around five constituencies, with one being graduate students. The task force will present an overall set of prioritized recommendations to the Executive Cabinet in December.”

CHRIS DEMBIA/The Stanford Daily

A history of rising costs

Many protesters held posters that detailed the steady rise of dependent plan premiums over time. Since the 2013-14 school year, the cost of the dependent plan has risen by around 80%. In the past year alone, the plan’s costs have increased by 12.2% to 15.0%, depending on how many dependents graduate students have.

For a graduate student with a spouse and a child, this translates into an increase in monthly premiums from $496.08 to $893.69. According to the SSN’s website, University-insured graduate students with a spouse and child living in the lowest-cost University housing “can find themselves with $7 or $10 in take home pay a week, to feed and clothe their entire family.”

Correspondingly, the number of dependents enrolled on the plan has also fallen. While data is not available on the number of enrollees since the 2016-17 school year, between 2013-14 and 2016-17, the number of dependents enrolled fell from an average of 541 dependents a month to 389 dependents.

“Stanford’s focus is on austerity,” Modica said, pointing to Stanford’s attempt at removing $1.7 million of stopgap funding for the Stanford University Press as evidence. “I think they’re trying to create a death spiral [for the plan],” she added, referring to a scenario in which increasing premiums cause students to leave the plan, contributing to further rate hikes until the plan is removed. “But of course, I don’t know what’s happening in their heads.”

According to Vaden Health Center’s website, the smaller pool of dependent plan enrollees makes the program more vulnerable to spikes in utilization than the larger student-only Cardinal Care plan, which can better diversify risk due to a higher number of enrollees. 

SSN has consistently emphasized the discrepancies between Stanford’s health insurance premiums and those at its peer institutions. SSN data suggests Stanford’s costs exceed those of peer institutions like Princeton, MIT and Yale. 

In response to rate hikes, Stanford introduced a pilot graduate student Family Grant in the 2018-19 school year to provide up to $10,000 per year per family to cover expenses like childcare, healthcare and rent. The Family Grant was approved for a second year in 2019-20. Stanford additionally convened an Affordability Task Force in May as part of the University’s long-range planning effort that includes a stakeholder team to discuss graduate student affordability concerns.

Modica explained the grant’s implementation was preceded by student activism.

“We flooded Vaden with calls,” she said. “We were able to get the grant to cover rising costs. They said it was only a one-time grant, so we did it again the next year, flooded administration with calls and meetings, and they agreed to do another grant.”

The petition’s text states the grant is not enough given “the combined burden of high rent, healthcare and child care costs for students with families.”

While Brubaker-Cole and Bent did not specifically address this claim, they wrote in an email to The Daily, “Our work with the Stanford Families Working Advisory Group has been productive, and we continue to collaborate. Student input informed our decision to subsidize dependent care and establish the Graduate Family Grant Program, which can be used to help pay for health insurance.” 

Some students, however, remain skeptical of the adequacy of the program.

“The family grant is just a pilot program,” said Jacob Ritchie, a graduate student and co-chair of Stanford’s Young Democratic Socialists of America chapter on campus, which helped SSN distribute the petition. “Parents need clarity from the University that they will be able to afford to live here over the long term.”

‘Not today,’ Brubaker-Cole says

After Modica and Román met with administrators in Bent’s office, they invited them outside to face the crowd of protesters and listen to students’ emotional stories about their families’ struggles with rising dependent healthcare costs. Bent, Stacey and Brubaker-Cole stayed for the duration of the rally, during which five graduate students shared their experiences. 

Several students grew teary-eyed as they recounted being faced with difficult decisions in which healthcare costs threatened the health and safety of their loved ones. 

“Every single graduate student is either directly affected by this issue or knows someone in their immediate community that is affected by this,” said Katherine Whatley, a current graduate student and SSN’s media representative. “It’s not an issue that’s going to go away. It’s an issue that grad students are gonna become more and more aware of.” 

After members of the graduate student community gave speeches recounting their own personal difficulties with Stanford’s healthcare plan, Modica directly confronted the administrators. “Is Stanford able to make a commitment today to making dependent healthcare coverage actually affordable?” she asked. 

“Not today,” Brubaker-Cole responded. 

Nonetheless, Brubaker-Cole appeared receptive to the concerns of the students, offering to begin a broader discussion on graduate student healthcare in light of the protest.

“I want to extend my thanks to all of the students who spoke to us here today,” Brubaker-Cole said. “I share your hope that we will find a solution to this problem.”

“We really appreciate hearing from the students … and we will take your message back to others at the University,” Bent added.

Student testimony

At the rally, and in interviews, students expressed a variety of concerns surrounding the plan.

Mei Li Inouye, a graduate student, shared the ways in which Stanford’s lack of affordable dependent healthcare has impacted her overall financial security. 

“I’m juggling dissertation, job applications, relationships, kids, anxiety, on insufficient funds … Will I finish my dissertation and get a job before I am physically, emotionally, and financially spent? Affordable healthcare would make it possible for me to pursue a career as a woman in academia without constantly worrying about our financial precarity,” Inouye said. 

In addition to the financial consequences for graduate students, Modica noted that the unaffordability of the plan poses a unique threat to international students, as international students’ visa status could be jeopardized if they adopt public assistance

Standing next to her young daughter who was in a stroller, Joanna, the wife of a current graduate student who wished to be solely identified by her first name due to citizenship status, recounted the difficult healthcare decision she faced as a recipient of an F-2 Visa. 

“Enrolling her in Stanford’s plan wasn’t really an option, as it would have consumed two-thirds of the $300 we are left with each quarter to pay” after food, gas, rent and healthcare, she said. Her alternative was MediCal enrollment for $13 a month.

Joanna feared the potential consequences of enrolling her child in a state-sponsored healthcare plan as a non-citizen. She cited Stanford’s Bechtel International Center warning that “a visa application may be denied or the applicant may be denied entry to the U.S.” if they choose to place their child on a public insurance plan. However, she ultimately decided to swallow the risk and insure her child.

In addition to drawing a connection between this issue and immigration policy, Modica listed the lack of free dependent healthcare as a contributor to the lower percentages of women in Stanford’s graduate school and teaching staff, compared to the undergraduate population. 

“Where are we losing women in the pipeline?” she asked. “Dependent healthcare is a reproductive freedom issue. I’m 32 years old, and if I had wanted to have children, I’d have needed to make a choice between that and an academic career. I shouldn’t have to make that choice, and it’s terrible, but children are not a possibility for me since my economic resources are so strained.”

Some students even found themselves and their loved ones traveling outside of the country just to receive adequate and affordable care. 

Román, an international graduate student, recounted an incident during which Stanford denied healthcare to his pregnant wife, who needed an emergency ultrasound for bleeding. 

“At the ultrasound lab, the front desk person told us that they could not corroborate our insurance coverage,” he said. 

Without insurance, the cost of the ultrasound was $2,000 and another appointment could not be scheduled without a wait. Román ended up flying his family to Mexico, both due to the urgency of the ultrasound and the lower cost. There, he learned his wife had miscarried. 

University administrators declined to comment on specific cases, including Román’s. 

Román said, “It was the most devastating experience you could imagine, and I was questioning, why am I in this as a Stanford student, why was I denied care?”

Additionally, Román added that after he explained his situation to the doctor in Mexico, the doctor waived his health fees: “A doctor in Mexico, who did not know me, showed more sympathy for my family than the school I pay $700 a month in premiums.”

This article has been corrected to reflect that a quotation from Mei Li Inouye refers to “financial precarity,” not “financial preparity.”

Contact Georgia Rosenberg at georgiar ‘at’ stanford.edu and Kate Selig at kselig ‘at’ stanford.edu.