Delivering American University's news and views since 1925. | Saturday, January 19, 2019

AU may broaden insurance

Next academic year could mark the first time AU students participating in the university's health insurance program will have access to human papillomavirus (HPV) and transgender health benefits.

The new provisions, pending administrative approval, would make AU the first university in the District to cover HPV testing and the Gardasil vaccination for female students and gender identity and hormonal care for its transgender population.

University administrators began pricing the two additions after students last fall expressed dissatisfaction with their exclusion, said Dan Bruey, director of the Student Health Center.

At the time, the university opted not to cover Gardasil because it seemed expensive, risky and wasteful, as more freshmen women were matriculating already having received the vaccine, The Eagle previously reported. By contrast, AU also excluded transgender care because of uncertainty over which benefits to provide - sexual reassignment surgery, hormone therapy, gender identity counseling or some combination of the three - and how to price them.

Despite the university's commitment to including these new provisions, many of AU's earlier concerns still remain unresolved, Bruey said. For example, GM Southwest, AU's current insurance provider, initially estimated that HPV testing and vaccination benefits would increase students' yearly bills by about 2 percent, or roughly $31. However, AU's current insurance plan already covers HPV testing, so it is likely that GM Southwest's initial pricing is too high, Bruey said. The office expects updated information to arrive some time next week.

The insurance company's transgender benefits breakdown is similarly unclear, he said. The two options GM Southwest offered - which would cost each enrolled student between $15 and $35 next year - specify lifetime benefit caps and inpatient/outpatient care limits but offer little insight into which specific treatments would be covered.

In the coming weeks, the Health Center hopes to negotiate for students the same transgender benefits the university previously added to its faculty and staff insurance packages, according to GLBTA Resource Center Director Sara Bendoraitis, who has worked closely with Bruey on developing this portion of the plan.

"[The staff package] was the proposal that was sent to GM, and the plan they proposed back was not the same," Bendoraitis said. "At a minimum, [we want the student plan to include] psychological services and prescription benefits for trans-related care; these would be additional services offered on top of the 'traditional' benefits."


Yet, it remains unclear whether students at large still support changes to their insurance packages.

In fact, in the Health Center's annual satisfaction survey, more than half of participating plan respondents rejected Bruey's proposal to add transgender care to student health insurance. Only 51 percent indicated they were willing to pay extra to cover the HPV vaccine.

The compelling force in both instances is likely economic in nature, Bruey said. Offering two expensive benefits in addition to next year's expected 8 percent inflation hike could raise students' annual bills by $182 at most, bringing their premiums from $1,440 to $1,622.

These increases underscore an unavoidable dilemma: AU's health policy requires all students to purchase an insurance plan, either through the university or independently. But for those students who hoped to switch to AU insurance next year to save money, or for those who have embraced the university's plan because of personal financial hardship, HPV and transgender benefits come at a hefty price.

"Any time students are asked generically if they want to pay more, the answer will always be 'no,'" Bendoraitis said about this paradox. "If the students had been asked, 'do you believe that we should provide insurance that is inclusive for all of our students .' I would venture to say that there would not be as many that would say 'no.'"

For that reason, AU Student Government President Seth Cutter said he believes the survey's results are misleading. The same ambiguity that has thus far stymied administrators may have also affected students' decisions to support HPV and transgender care inclusion, he said.

Moreover, it does not help that a majority of the survey's respondents were law students, most of whom are now too old by the Food and Drug Administration's standards to be eligible for the HPV vaccine, Bruey said.

"I wonder how much of this response is based on a lack of information, or perhaps it's students who have already received the HPV vaccine," said Women's Initiative Director Ashley Evans. "Students may say, 'no, we should not pay more,' but we must say as a community that we are willing to pay more and make the commitment to do what's right."

In an effort to balance these competing concerns, Bruey's office also opted to poll students on a number of proposals that, combined, would abet next year's expected premium increase, HPV and transgender benefits included. The options, which would require students to pay more in medicine or emergency room co-pays, would immediately lower next year's insurance bills.

However, students largely disapproved of those revisions - a reaction that the Health Center will mostly heed when finalizing its 2009-2010 insurance plan, Bruey said.

"We ask these things every year, but we know from students who come here that they do not . want to pay more out of pocket at their initial use of health care," he said. "But we're trying to send the message to students that we're doing everything we can. We understand the hardships they face."

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