Research Statement on the Equal Access of Healthcare at BYU-Idaho
The Equal Access Commission strongly believes in equal access of healthcare for all individuals. Recently, BYU-Idaho’s (BYU-I) has announced it will no longer recognize Medicaid as a valid form of insurance for students. (Hereafter the “Medicaid denial”). We release the following statement regarding our concerns:
The Mandatory Healthcare Requirement
Colleges across the nation require that students have a form of healthcare.[1] This requirement is beneficial as it limits liability for the school and ensures students have healthcare for their needs, allowing them to focus on school and progress towards graduation. Universities have the ability to choose what insurance they will accept in their student health centers; however, students have the right to choose healthcare off campus to best suit their needs. Thus, students have every right to an insurance that is based on their needs and socioeconomic level. Declaring Medicaid an unacceptable form of insurance is prejudiced against socioeconomically disadvantaged, marginalized, and disabled students.[2] Denying Medicaid as health insurance hurts the students who are most in need.
We reaffirm Idaho’s statement regarding the healthcare requirement: “[G]ood health is essential to achieving your educational goals, and access to adequate healthcare and medical coverage is essential to your good health. Without adequate coverage, unexpected medical expenses could alter your future dramatically.” [3] Medicaid is a resource that eliminates unequal access in education for students.
Medicaid as a “Adequate” Health Insurance
The current statement from Scroll, BYU-I’s newspaper, states “BYU-Idaho requires students to either have ‘adequate’ health insurance coverage in the Rexburg area or “participate in the Student Health Plan.” [4] Medicaid is a legitimate health insurance provider that is more than suitable to satisfy the requirement of “adequate” health insurance. (See further Commission research on the comparison of Medicaid and the Idaho Student Health Plan). Medicaid and CHIP services take up 17% of the market share of the US healthcare system, providing for almost 72 million individuals.[5] Medicaid provides “full medical coverage” for students' healthcare needs and thus helps colleges maintain low risk of liability while keeping students healthy and safe.
Medicaid and its Comparisons
Students use Medicaid because they do not have the resources to pay for private health insurance. [6]Additionally, many students are not covered by their parent’s insurance and do not work in jobs that provide insurance. Not every student has private insurance available to them. Thus, although BYU-I continues to allow Medicaid as a supplement (secondary insurance) to a primary insurance, for many students Medicaid is their sole insurance option. Furthermore, many individuals who have Medicaid are also receiving other government coverage such as Supplemental Security Income (SSI). Students use SSI benefits and resources provided by these programs to pay for necessities like food, clothing, and housing. Medicaid is provided to individuals on SSI/SSDI because they do not have the money to pay for private insurance. Medicaid helps those who are disabled, elderly, pregnant, or socioeconomically disadvantaged receive equal access to healthcare, enabling them the equal opportunity to focus their energy on school. Without Medicaid, students’ medical expenses will “alter [their] future dramatically.”[7]
The Student Health Plan may not be a viable alternative to Medicaid or a private insurance company for some students. The health plan may not be an equal economic alternative. The plan per semester costs $536 for a student or $2130 for a student family.[8] Additionally, students may need to pay for the plan when they are off-track from school, because of BYU-I’s three track system.[9] Therefore, the Student Health Plan may cost upwards of $1600 per year for one student. This does not include copays for students that have various medical issues and specialists that the student health center cannot provide.
Additionally, the Student Health Plan may not be an equal medical alternative. The Student Health Center “care[s] for most common conditions and will assist with referrals to specialists or to the emergency room as needed. We do not intend to replace the care from your home physician but strive to support that care when possible at a primary care level.”[10] Many students are on Medicaid because of pre-existing conditions and disabilities.[11] These students may need more than ‘primary care level” for “common conditions.”[12] The Student Health Plan was modeled to help those with minor heath occurrences such as a cold, or a twisted ankle and was not designed for those with lifesaving medical needs such a catheter and ostomy supplies, as well as durable medical equipment needs like hearing aids, wheelchairs, and lifts. (See further Commission research).
Therefore, in addition to Medicaid coverage they have, BYU-I is effectively compelling students that are already disadvantaged to pay the university for the student health plan that the students do not need and do not have the resources for.
Addressing Concerns of Medicaid Expansion
We now address BYU-I concerns about students overwhelming providers in the area. This concern likely stems from the fact that Idaho has recently expanded Medicaid. This Medicaid expansion was done through legal means of democracy and the representation of the people. Idaho voters approved this initiative by a wide margin (60%) in the 2018 election.[13] The students that have or recently received Medicaid through the expansion, have Medicaid as a legal form of health insurance. Providers across the state have known this Medicaid expansion was in progress in legislation and are already providing care and rearranging any existing methods that would need to be reorganized in order to accommodate for Medicaid expansion.
Additionally, If BYU-I continues to deny acknowledging Medicaid as a “adequate” health insurance, this will not prevent students from using their legal right to Medicaid. Thus, regardless of BYU-I’s Medicaid denial, providers may or may not be overwhelmed regardless. Additionally, students now covered under Medicaid expansion may have had another insurance before the expansion. BYU-I’s Medicaid denial will likely not change the overall influx of Medicaid patients. Therefore, this concern of overwhelming providers in the area must be justified by BYU-I.
In conclusion, BYU-I’s Medicaid denial policy is unlikely to change the issue surrounding Medicaid expansion. Medicaid has strict analyses for how much a healthcare service is worth and thus reimburses physicians less for services than many private insurances.[14] While we acknowledge this is an important issue to address for the benefit of patients and providers, we believe this is out of the scope of a solitary private university to try to solve. The state and federal government is in control of how the Medicaid expansion is implemented. To address concerns over “overwhelming providers,” the state must re-analyze their current Medicaid fee schedule, and inspect current reimbursements they furnish healthcare providers to be fair to providers. [15]
Addressing Medicaid Denial and Discrimination
BYU-I has also expressed the Medicaid denial policy is in response to discrimination against students with out-of-state Medicaid. While these students may need further assistance to navigate their healthcare needs, the Medicaid denial does not provide any new resources than what they already was put in place for such students: the Student Health Plan.[16] Before the Medicaid denial policy was put in place, BYU-I only accepted “Idaho full-coverage Medicaid” as satisfying the requirement.[17] While Medicaid does not have residency requirements, college students would be unduly burdened by switching their coverage from state to state every few months, depending on if they went to their home state for summers between school years. This unfortunate gap of student healthcare has not changed with the implementation of the Medicaid denial policy. Creating discriminatory policies surrounding Medicaid disproportionately affects marginalized students.[18] The Medicaid denial will only serve to further deter disabled, socioeconomically marginalized, and minority students from attending the university. This limit of diversity will restrict academic rigor and impede exposure to different ideas. [19] BYU-I’s denial will likely discriminate, not prevent discrimination, against students.
We call on BYU Idaho to further explain the purpose of refusing Medicaid and ask that they respectfully reconsider their policy in order to provide for the health and safety of their students. We ask BYU-I to gather Medicaid expansion research from medical providers and unbiased healthcare organizations to see if claims of “overwhelming providers” are well-founded.
The commission does not have further information from BYUI and at this time acknowledges that further statements are needed from the school to accurately assess the Medicaid denial. This statement may be revised as necessary.
[1] http://www.collegescholarships.org/student-living/health-insurance.htm; https://www.acha.org/ACA_FAQ
[2] https://www.healthcare.gov/medicaid-chip/getting-medicaid-chip/
[3] https://www.dmba.com/nsc/handbooks/student/hbbyuldsbc2019.pdf
[4]https://byuiscroll.org/students-confused-after-university-stops-accepting-medicaid-as-waiver-for-student-health-plan/
[5] https://www.medicaid.gov/medicaid/program-information/medicaid-and-chip-enrollment-data/report-highlights/index.html
[6] https://www.medicaid.gov/medicaid/eligibility/index.html
[7] https://www.dmba.com/nsc/handbooks/student/hbbyuldsbc2019.pdf; https://www.macpac.gov/wp-content/uploads/2017/03/Federal-Requirements-and-State-Options-Eligibility.pdf; https://www.npr.org/sections/health-shots/2015/07/23/424990474/why-disability-and-poverty-still-go-hand-in-hand-25-years-after-landmark-law?fbclid=IwAR2Mq46pRyOqMDp92Rx7Xiv7AqJB0ZfSSRDOMpgQVE8DVEJtZ8WoqmQa30I
[8] http://www.byui.edu/health-center/student-health-plan
[9] http://www.byui.edu/health-center/student-health-plan; http://www.byui.edu/admissions/three-track-system
[11]https://www.macpac.gov/wp-content/uploads/2017/03/Federal-Requirements-and-State-Options-Eligibility.pdf
[12] https://www.byui.edu/health-center/our-services/primary-care
[13] https://sos.idaho.gov/elect/results/2018/General/statewide_totals.html
[14] https://www.journalacs.org/article/S1072-7515(07)01164-7/fulltext; https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4193371/; https://www.healthcaredive.com/news/cbo-reports-show-private-insurers-pay-physicians-hospitals-far-more-than-m/445949/; https://www.cbo.gov/system/files/115th-congress-2017-2018/presentation/52819-presentation.pdf
[15] https://healthandwelfare.idaho.gov/Portals/0/Providers/Medicaid/FeeScheduleJan2019.pdf
[16] https://www.dmba.com/nsc/handbooks/student/hbbyuldsbc2019.pdf
[17] http://www.byui.edu/documents/health-center/Forms/Student%20Health%20Plan%20Waiver.pdf
[18] https://www.macpac.gov/wp-content/uploads/2017/03/Federal-Requirements-and-State-Options-Eligibility.pdf
[19] https://www.ncbi.nlm.nih.gov/pubmed/28631304; https://www.petersons.com/blog/diversity-at-colleges-and-universities-through-multicultural-recruiting/
The Commission’s Response to the Daily Universe Article June 6th, 2019:
It is unfortunate to see that the Daily Universe has decided to publish a misleading and false narrative. Despite this misinformation, we will continue to work with BYU to help current students and future students. Please view our prior statement on the Universe on May 25th here, and a comprehensive analysis of the article here. Kendra Muller is passionate about working to help accessibility any way she can and the portrayal that she has ulterior motives is completely false. She has helped with social media outreach and has been a guinea pig to test the Portal door device, like many other students in wheelchairs at BYU. She has helped Portal Entryways because she thinks it can be a huge benefit to disabled people, but is not rewarded with any commission for sales. The text from the report says: “BYU should actively seek ways to help its students by implementing different doors systems that students have specified. This includes Portal Entryways, or fob controlled doors, installed at Heritage Halls.” The Commission used Portal Entryways as an example of an accessible door system, because it was started by BYU students, tested by disabled students at BYU, and because administration was already familiar with it. We are very excited for any improvements BYU is making by integrating Kindoo to help its students. This was a product unknown to the Commission and any of the disabled community members we spoke with. The Commission is, of course, supportive of all BYU-led accessibility ideas that would benefit BYU students, including: Portal Entryways, SpeechCloud, and Accessible Maps by the BYU All Access Club, Gender Neutral bathrooms project, transportation to devotionals for those with mobility disabilities, and a recent renovation project to make the BYU Gym more accessible. The Commission has recommended that BYU test and implement accessibility improvements designed by BYU’s own students. The Commission stands by the statement that BYU has thus far “failed to do so.”
We refer anyone with questions to view our findings themselves. Our approach is to provide a platform for students with disabilities to give their experiences and provide a comprehensive database of these experiences so that recommendations can be implemented. The individual experiences of students are powerful and cannot be ignored. To completely disregard any of the student experiences is irresponsible. Each should be thoroughly considered and evaluated to determine what that experience teaches regarding inclusion efforts.
The Commission’s Response to the Salt Lake Tribune Article June 2nd, 2019:
On June 2nd, 2019 The Salt Lake Tribune published an article on the Equal Access and Disability Rights Commission and its goals for BYU. This article details the methodology of the Commission and the rights of disabled students. We applaud the efforts of the Tribune in providing a space for disabled voices. We urge all to research our the Commission's findings here. Our research is also triangulated by several other academic research articles published by BYU professors on accessibility at BYU. Find these complementary sources of research here.
The Commission’s Response to Brigham Young University:
We welcome the BYU administration and the Disability Standards Compliance Committee to respond to the Commission and work collaboratively with disabled students to start addressing feasible solutions. In the motto of the disability rights community, ‘Nothing About Us Without Us,’ we seek to work together. The Commission’s research hinges on a methodology of truth commissions, a widely-practiced technique of transitional justice. Truth Commissions are a valid research technique and do not require individual statements to use legal jargon in explanations of their experiences. Some exaggerations are to be expected. Small discrepancies do not override evidence from personal experiences of students. It is not reasonable to expect disabled students to speak as in a court of law. Our research is also triangulated by several other academic research articles published by BYU professors on accessibility at BYU. Find these complementary sources of research here.
While we have not yet received any response to our recommendations from BYU administration, the Disability Standards Compliance Committee, and the University Accessibility Center, we are grateful to the many BYU professors who have responded. Many professors have asked what they can do to facilitate a better experience for disabled students in their classrooms. These faculty have promptly taken positive steps and used our resources to create better inclusivity for their students. We thank all those who have done so and hope others will follow suit.
Commissions Response to The Daily Universe May 25th, 2019
On May 25th, 2019 The Daily Universe reached out to write an article on the Commission, after deleting two articles, one of Kendra Muller published April 17th and one of the Commission written and published April 25th respectively. The April 17th article is found here and was taken down unknowingly. It has now been republished as of 6/11/2019. The April 25th article was a fake published under the reporters name. She petitioned to have it taken down because she did not write the article and was never informed it would be released. She also changed her major because of this instance. We have saved both of these articles in a database for historical purposes. We encourage truthful and accurate reporting and hope for a representative perspective from the university journalism. While we have advocated for all BYU students that have created unique and helpful things including Portal Entryways door opener, accessible maps, and technology to enhance transcription services, they are not affiliated with the research. The Commission’s case study concerning BYU is completed and an article is unnecessary, we acknowledge the Daily Universe’s commitment to excellence in wanting to complete the unfinished article. The Commission’s research continues to provide a resource for BYU’s community of students and faculty. We look forward to engaging and reading the completed article.
Commission’s Response to Channel 2 April 26th, 2019
In the Channel 2 News story that ran on Friday, April 26th, 2019 at approximately 6pm, we acknowledge that there were some exaggerated statements made, however, we appreciate the work of Brian Mullahy in reporting on these important issues. The story began by saying that we “accuse” BYU, and we feel that language does not accurately characterize our intentions. We hope to work together with BYU, not pursue legal action or simply shame the university. We specifically acknowledge that a relatively high percentage of the handicap doors do indeed work, but we feel that improvements can still be made in this area. We apologize for any exaggerations that were present in student statements from our Final Report. The news may sensationalize these issues, but the facts remain that disabled students are unable to access restrooms, have been denied accommodations, refused parking passes, and left stranded in buildings during fire drills. We are glad to hear that BYU is open to suggestions on how to improve accessibility and will be expecting a reply from administrators soon.