Last week, nearly 100 graduate students, along with their spouses and children, demonstrated outside of Vice Provost for Graduate Education Stacey Bent’s office to push for affordable dependent health insurance.
As medical students at Stanford, we feel deeply concerned about the University’s health insurance policies for the spouses and children of its graduate students. Over the past six years, dependent healthcare coverage costs increased by 80%. As a result, Stanford graduate students with dependents face a catch-22: pay $893.69 per month for their dependents’ coverage or risk the consequences of no coverage at all. As it is, the Stanford graduate stipend is insufficient to cover graduate student living expenses, and with this added expense some students find themselves with $7-10 in take-home pay a week to feed and clothe their families. For those without insurance, the consequences can be dire: One graduate student’s wife whose dependent healthcare could not be corroborated by Stanford had a miscarriage after she abstained from receiving a $2,000 emergency ultrasound at Vaden.
Vaden’s response is that lower enrollment numbers have made increasing premiums inevitable, but that is frequent rhetoric in insurance policy debates. With fewer patients to pool funds, each patient needs to pay for a bigger slice of the pie. After the passage of the Affordable Care Act (ACA), only half of the uninsured citizens predicted to sign up for health insurance by 2017 actually did. No wonder the costs of ACA plans became so high, or so the argument goes.
The problem, quite clearly, is that this argument can be reversed. Fewer enrollees may justify higher premiums, but higher premiums will certainly lead to fewer enrollees.
Limiting access to care is not just bad health policy. It is bad business. The Stanford graduate students who do not purchase costly insurance for their dependents will not save Stanford money. Their spouses and children will become sicker, meaning more visits and higher healthcare expenditures for themselves and for the clinic. This phenomenon was demonstrated decades ago, during the famous RAND health insurance experiment, in which enrollees with high user chargers avoided cost-saving preventative and primary care visits — leading to greater healthcare utilization later on. More recently, Stanford’s very own researchers have published research demonstrating the inverse relationship between out-of-pocket costs and preventative care use.
For potential graduate students, high healthcare costs for dependents could make Stanford a less attractive option when choosing amongst graduate programs. International students — who comprise 34% of the graduate student body — may prioritize healthcare offerings even more, since they may be labeled as “public charges” if they enroll dependents on public insurance plans. This could harm their chances of receiving a green card, a prerequisite to citizenship. Does Stanford really want to dissuade these students from being part of our community, on top of bearing the repercussions of bad press?
Most importantly, these rising prices harm the loved ones of graduate students and, consequently, the wellbeing of graduate students themselves. How is a Ph.D. student supposed to focus on her thesis if she is too concerned about how she will pay for her son’s insulin medication or his upcoming surgery — one that could make the difference between life or death?
There are many ways to make these health plans more affordable. The most effective would be to make dependent healthcare coverage free for all graduate students’ children and all spouses who are unable to receive healthcare through their employers (e.g. F-2 visa holders). While some may argue that this would be costly, the proposed long-term cost is merely 1/1000th of Stanford’s endowment, and the potential benefits outlined above — healthier students and families, lower overall costs due to increased utilization of preventative care, competitive recruitment relative to peer institutions — unequivocally make this investment well worth it for the University. At the very least, setting lower premiums would lead to greater enrollment, consequently bringing premium costs down even further as more patients contribute to the insurance pool. Another coverage solution could be through value-based insurance design, which could encourage positive health behaviors and save money for Stanford long-term. Some of our own faculty are looking into innovative ways to design these types of insurance schemes at the national scale. Why not bring this type of research to our own campus?
As physicians in training, we cannot stand by as one of the richest universities in the world fails to provide affordable healthcare for its students and families. Stanford should commit to improving the health of its students and their dependents — not merely profit from it.
— Soleil Shah M.D. ’23 and Bianca Mulaney M.D. ’23
This article has been updated to more clearly reflect the insurance circumstances of the dependent who had a miscarriage after abstaining from an ultrasound.