During clinical training, medical students worry about caring for patients, learning how to do procedures, memorizing drug interactions, and documenting their work in the electronic medical record —they shouldn’t be worried about paying medical bills at the same time. Shortages of personal protective equipment and the subsequent dangers of working in health care permeate the news and threaten our ability to overcome the COVID pandemic. However, there is another often-neglected safety conversation — the need for adequate insurance coverage to ensure that anyone who needs to can be tested and treated without fear of debt.
Among those with inadequate health insurance are the University of Washington medical students. In fact, there is no health insurance plan for the majority of students at the University of Washington. State legislation limits public universities from offering plans to students, except for some graduate students who are considered employees. Medical students are considered professional students and thus not eligible for those health insurance plans. The alternative is for students to sign up for Medicaid, which provides comprehensive coverage at no cost within Washington. However, outside our state borders, it immediately dwindles to emergency-only coverage.
This is a problem for medical students because one of the advantages of attending the University of Washington School of Medicine is the unique privilege of training at clinical sites across Washington, Wyoming, Alaska, Montana, and Idaho. This opportunity develops relationships with underserved communities and prepares us to work in a variety of clinical settings, including rural areas. Unfortunately, for students with chronic medical conditions, disabilities, or who require more than emergency-only coverage, this regional training presents serious challenges. Health insurance that functions across the five-state region can cost upwards of $400 per month. The majority of medical students rely on loans to cover their tuition and living expenses during their training. Insurance premiums that cost hundreds of dollars a month could add more than $20,000 in loans to the cost of training, before interest accrues. This exacerbates medical student debt and makes the regional training program less accessible to students with higher medical needs and fewer financial resources.
As part of our training, we learn to ask patients about their insurance status because, although it shouldn’t, the type of insurance you hold (or don’t) affects the care you receive. An internal survey of current UW medical students found that 5% of students are uninsured, and over 50% are currently on Medicaid. As a result, our classmates have faced substantial hospital bills and been forced to go without their medication while learning as University of Washington medical students.
A classmate with a chronic medical condition needed a friend to pick up and mail necessary medications twice a month from Washington to another state because their Medicaid plan would not mail prescriptions to addresses outside of Washington. Without a friend in the state of Washington willing to do this extra work, they would have needed to pay full price out of pocket for their medications. Another classmate with a chronic condition had a change in their family situation, which prevented them from qualifying for Medicaid, but left them still unable to afford unsubsidized insurance. As a result, they went three weeks without medication they needed. Another student paid more than $10,000 for an emergency room visit while training at a site outside of their home state.
Everyone should have access to health care, but the irony of inadequately insured medical students is particularly poignant. The Association of American Medical Schools released a memo in 2005, which stated that all medical students should be insured, but while there has been much research into the attitudes of medical students towards private vs. public insurance, there has been little investigation into the insurance status of students in the last twenty years.
The health insurance challenges medical students face are just a snapshot of a larger problem that plagues our country. We are not alone in the risks we face as uninsured or underinsured. While 64 million people have access to coverage through Medicaid, about 27 million people between the ages of 18-64 remain uninsured. It’s hardly a new narrative. The COVID-19 pandemic has laid bare the vulnerability of our systems and the gaps in our policies. The threat of on-the-job exposure is likely, and the risks that many people face, including medical students, are not abstract.
We ask that the Washington State legislature amend the current legislation to offer an opt-out option for all students and explore additional strategies to improve insurance access for students across our state. We ask the Association of American Medical Colleges to reaffirm their commitment to health insurance access with a robust backing through LCME accreditation. We ask that our country moves towards comprehensive health insurance for all. We can no longer allow people, no matter their professions, to fall through the gaps of a crumbling safety net, whether there is a pandemic or not.
Zannah Herridge-Meyer, Melanie Langa, and Kelly Stewart are medical students.
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