The Health Insurance Crisis No One Talks About

Authored by: Victoria Wroblewski

Art by: Laura Lee

Confused by health insurance? You’re not alone, but your wallet might be paying the price. Health literacy is crucial for making informed decisions that will have a lifelong impact. In the United States, 88% of adults have substandard rates of health literacy [1]. As of today, healthcare avoidance and poor health literacy rates are continuously increasing given the complexity of the US healthcare system. Consequently, it is evident that one of the leading causes of health accessibility gaps includes inadequate education on health insurance and coverage plans. 

A majority of college students are not well informed of the plans or options that are available to them upon graduation. For example, a health insurance literacy study revealed that “only 14% of the individuals were able to correctly answer four questions about deductibles, copays, coinsurance, and out of pocket (OOP) maximum” [2]. These are basic terms which are constantly encountered in health-related decision making processes. It is essential that all adolescents acquire knowledge and awareness on the topic of health insurance, so they are prepared for when they are eligible or legally required to enroll. In fact, shouldn't universities which claim to be getting individuals ready for the “real-world” also prepare them for the most significant aspect of life: their health?

While college institutions aim to provide an education, grow knowledge, and teach valuable life skills, the importance of understanding insurance terminology and health benefits often go unnoticed. The Director of Health Services at Monmouth University revealed that students “rely on their parents to take care of any health insurance related questions or to navigate the insurance system” [3]. Health coverage may not be an issue for students while in college due to a college-oriented insurance plan or dependence on parents’ coverage. However, coverage by a parent based plan ends upon turning 26. Adults between the ages of 19 and 34, notably after graduation, have some of the highest uninsured rates: 15.6% uninsured [4]. Since it can be an overwhelming process adjusting to independence, students do not know where to begin. They often fall into medical bankruptcy, the inability to pay off medical costs which accumulate quickly. Additionally, The Health Care Debt Survey conducted by the Kaiser Family Foundation finds that four in ten adults have some form of health care debt and about one in five say they do not expect to ever pay it all off [5]. Young adults are often taken advantage of by the healthcare system during medical visits. Simply, they do not have an understanding of valid cost estimates or know what questions to ask. The lack of knowledge and financial health literacy evidently causes problems which could be avoided with a standard health coverage education.

When taking a look at the United States, there is a vast amount of students coming to study internationally from various countries across the globe. International students are one of the largest student populations that face the consequences of limited health literacy. Particularly, this occurs due to language barriers, differing communication styles, and the overall adjustment to a new environment. Many students are not even aware of their obligations or are not fully informed prior to their arrival. In a research study which examined health insurance literacy and healthcare utilization of international students at a university in a metropolitan Midwestern area, 73% of the participants reported that they feel confused about their health insurance [6]. With that, international students tend to underutilize their medical care or are not familiar with the difference in healthcare style compared to their home country. For instance, students bring their prior health knowledge and medications, resorting to self diagnosing and self treatment rather than visiting medical offices. This can occur in a variety of ways. An example in the US includes Latino and Afro-Caribbean immigrant communities placing an emphasis on religion and herbal medications [7]. All in all, international students are just one of the several student populations that are unable to acquire optimal medical care due to their limited guidance from these higher level institutions. While they are not alone, this is not ideal.

During the COVID-19 pandemic, many college students found it was required to better understand their health insurance due to the increased need for access to health services. Colleges slowly began accommodating more resources such as student health centers, health programs or initiatives, and online resources. Tyler Winkelman, M.D., a clinical lecturer at University of Michigan C.S. Mott Children's Hospital, highlights the importance of “mandating existing curricular standards to ensure students are exposed to health education topics”. It is in the hands of state and federal level clinicians, educators, and policy makers to make this happen [8]. These next steps in growing the significance of health literacy would provide students with vital skills. Students can apply such knowledge on a daily basis and carry it into their adulthood, saving money and gaining access to the services they deserve in the process. In order to ensure a healthier future, we must recognize the necessity of health literacy and make it more accessible.

References:

1. Dhananjeyan , D. (2024, January 3). Health Literacy in the United States. International Collegiate Journal of Science. https://icjs.us/health-literacy-in-the-united-states/ 

2. Nobles, A. L., Curtis, B. A., Ngo, D. A., Vardell, E., & Holstege, C. P. (2018). Health insurance literacy: A mixed methods study of college students. Journal of American College Health, 67(5), 469–478. https://doi.org/10.1080/07448481.2018.1486844

3. Lack of Health Insurance Education. Uninsured & Unaware. (2024, December 6). https://uninsuredunaware.org/uninsured-and-unaware-lack-of-health-insurance-education/ 

4. Alexander, B. (2022, August 8). Understanding Healthcare Options for college students. Journal of Student Affairs Research and Practice. https://naspa.org/blog/understanding-healthcare-options-for-college-students 

5. NPR. (2022, June 16). KFF’s Kaiser Health News and NPR Launch Diagnosis: Debt. National Public Radio. https://www.npr.org/about-npr/1105573129/kff-s-kaiser-health-news-and-npr-launch-diagnosis-debt#:~:text=About%204%20in%2010%20adults%20report%20having%20medical%20or%20dental,ever%20pay%20it%20all%20off. 

6. Liu, E., Arledge, S. A., Cai, M., Tao, D., & Li, W. (2023). Health Insurance Literacy and Medical Care Avoidance Among International Students: A Case Study. International Journal of Public Health, 68. https://doi.org/10.3389/ijph.2023.1605788 

7. Brenes F, Goldstein EV, Sarduy EL, et al. Botánicas Function as Health Care Safety Nets Among Hispanic American Immigrants: A Brief Report. Hispanic Health Care International. 2024;23(1):5-8. https://doi.org/10.1177/15404153241247261 

8. Joy, K. (2016, November 10). A New Prescription for K-12 Educators: Teach Kids About Health Care. Michigan Medicine. https://www.michiganmedicine.org/health-lab/new-prescription-k-12-educators-teach-kids-about-health-care