The nation's top health official struggled Wednesday to explain why policy cancellations and a crippled website have left many people _ including tens of thousands of suddenly uninsured community college students in New Jersey _ in a state of health insurance limbo.
Health and Human Services Secretary Kathleen Sebelius underwent heated questioning from Congress on continuing website problems.
Both she and President Obama went on the defensive against the growing outcry over cancellation notices that many insurance companies have sent to their customers. The new law outlaws many of the bare-bones-coverage policies that individuals, small businesses and colleges used to offer, and as a result many insurers have raised prices or scrapped plans altogether.
In New Jersey, college students who enrolled this fall were among the first to experience unforeseen changes in the marketplace, with many seeing their annual health insurance costs triple. At community colleges in Bergen and Passaic counties, students lost coverage altogether.
The cries of surprise and dismay have increased in recent weeks, as 800,000 New Jersey residents with individual or small-business coverage and 80,000 Medicare recipients with HMO-like Advantage Care plans learned they had to look for new coverage.
Sebelius pledged that her agency would have most of the glitches with the HealthCare.gov website fixed by the end of next month.
While the Obama administration urged patience, community college administrators in North Jersey are bemoaning the fact that the law has, for the time being anyway, left many of their students without insurance this fall as they wait for the problems with the federal marketplace to be resolved.
"This is an unintended consequence of the federal health care overhaul," said Jake Farbman, of the New Jersey Council of County Colleges. "In an ideal world, we want students to have access to health care and also want them to have affordable education."
The new federal law bans the sale of the types of bare-bones health insurance that colleges used to sell to such students _ policies that at some schools, like Passaic County Community College, had cost as little as $100 a year. The new plans now offer coverage for a range of services that some students likely needed but couldn't pay for _ from annual checkups to HIV screening to alcohol abuse treatment _ all with little or no co-pays and tightly capped annual deductibles.
With those added benefits, the annual cost of the policy offered this year to students at nine schools in the state rose to $1,050, three times what it was in the 2010-11 school year, said Paul Shelly, spokesman for the New Jersey Association of State Colleges and Universities.
The association's members include Ramapo College of New Jersey, William Paterson University and Montclair State University, which require all full-time students to have health insurance as a condition of enrollment. The insurance plan that Rutgers University offers its full-time students costs $1,473 this year, up from $951 the previous year. According to Rutgers, 21 percent of its full-time students buy insurance through the university.
The majority of college students have health coverage through their parents' policies, but an estimated 80,000 or more students have been buying coverage through their colleges. About 20 percent of students at New Jersey's large public universities _ and a third of the state's community college students _ arrive on campus without insurance, either because their parents don't have coverage for them or because they're on their own.
There is hope for some college students who need coverage and can't afford it _ they may now qualify for free Medicaid coverage. As part of the Affordable Care Act, Medicaid, the state-federal program to insure low-income mothers, the disabled and the impoverished elderly is being expanded. Childless adults with incomes below $15,282 now qualify, and college students who are no longer financially supported by their families could fall into that category.
"For uninsured students, who are largely also low-income, the law provides huge opportunities for them to get affordable care," said Christina Postolowski, senior policy analyst for Young Invincibles, an organization that is trying to educate college students about the options they have under the new health care law, including the prospect of enrolling in Medicaid.
State law used to require that all full-time students at all New Jersey colleges have health insurance. The law was repealed over the summer at the urging of community college administrators, who feared the new policies could cost their students $1,500 to $1,700 a year.
At Passaic County Community College, where the annual tuition is about $3,000, the prospect of tacking on a fee that size seemed unthinkable to President Steven Rose, whose college is no longer offering any student policies.
"That would have been enough of an increase to keep some people out of school," Rose said.
Community college officials say they will try in the coming weeks to help uninsured students investigate their options. Rose said Passaic Community has contracted with United Way to organize informational events and insurance counseling on campus.
At Bergen Community College, Sheila Thorne, an Englewood health care consultant who has held many health insurance informational sessions in New Jersey, has been asked to meet on Nov. 7 with a group of 10 students who want to help lead the charge in getting more of their classmates insured.
Thorne thinks that many uninsured students will qualify for either tax subsidies to pay for private insurance policies or will be able to enroll in Medicaid.
"I think probably a large percentage of them, particularly those who are financially independent of their parents, could end up being part of the Medicaid expansion," Thorne said.
The prospect of suburban college students joining the Medicaid ranks would "certainly change people's ideas about who they think of as being on Medicaid" and get people to stop thinking of the program as a pejorative, Thorne said.
Jhon Alzate, a 20-year-old Bergen Community College student, may be among the first to blaze that trail.
Two weeks ago, Alzate applied for coverage under NJ Family Care, the program that administers the state's Medicaid program. He is still waiting to hear if he qualifies.
"From talking with the person who helped me apply over the phone, it sounds like I'll be eligible," said Alzate, of South Hackensack, who is already facing $1,000 in bills from two emergency room visits to treat a still-undiagnosed illness. "I'm really hoping that ends up being the case."
"This has been a lot of stress with these hospital bills I've gotten," he said.
Whether uninsured students qualify for Medicaid coverage as individuals will depend on whether they are deemed financially independent of their parents.
"Income and household size are the determining eligibility factors," said Nicole Brossoie, a spokeswoman for the Department of Human Services. If a student is still listed as a dependent on parents' tax return, then the income of the entire household is considered in the application for Medicaid, Brossoie said.
Another uninsured Bergen student, 21-year-old Milap Patel, said he, too, will apply to NJ Family Care now that his insurance through the school has been discontinued.
He'd learned the hard way that the plan didn't cover much. While running to catch a bus last year, Patel fell and broke his pinky. Treatment cost $2,000 in hospital and doctor bills above what was covered by his college plan, he said.
"I was still new to the U.S. so I didn't know how expensive it was here," said Patel, a native of India. "Now I know I need to have insurance."
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