Yarbrough: A failing health plan

For most Yalies, a visit to the pharmacy often means a long wait in the cramped entryway of the University Health Services building. For me and other HIV-positive Yalies, however, it’s usually much worse.

We have to trudge down to the Walgreens on York Street to wait in even longer lines, often only to hear that our prescriptions cannot yet be filled because of problems with our insurance. This ritual inconvenience then triggers a complicated morass of communications with a host of bureaucrats from York Street to Hillhouse Avenue to Hartford, sometimes even to Walgreens headquarters in Chicago. As I write this, I’ve just — finally — received a refill I ordered over a month ago.

Why the endless hassle? Because the Yale Health Plan’s Prescription PLUS plan covers only 80 percent of our prescription drug costs. The remaining 20 percent amounts to about $500 every month for most HIV-positive patients. Living on a graduate student stipend of about $2,000 per month, I’m forced to rely on a targeted state welfare program to make up the difference.

This publicly funded program cannot distribute funds through private-membership pharmacies such as the one at YUHS. And so I trudge to Walgreens, where most pharmacy employees believe the store never accepts Yale insurance under any circumstances. It falls mostly to me to inform them that I fall in an unusual but crucial exception to that policy — and to walk them through the steps they have to take in their own computer system to execute this unusual billing arrangement.

And get this: I’m actually lucky because my chronic illness happens to be HIV.

Students and staff with other expensive-to-treat chronic illnesses often are not eligible for state assistance such as the programs targeted at HIV. While Prescription PLUS leaves me with a burden measured in hours, arguments and occasionally (and dangerously) missed doses, the burden borne by other chronically ill Yalies is also measured in dollars.

For all of us, this adds up to a massive distraction from our teaching and research work. It lengthens our time here and disrupts our focus, even beyond what would be medically required by the chronic condition alone. Simply put, Prescription PLUS in its current form doesn’t just fail to foster Yale’s core mission when it comes to the chronically ill. It actually impedes it.

Nor does Prescription PLUS serve healthier students very well. Between its roughly $750 annual premium and $100 deductible, Prescription PLUS enrollees won’t break even unless the full retail value of their annual pharmaceutical costs approaches $1,100. Few routine drugs cost that much. Even after the recent increase in birth control costs, for example, it still makes more financial sense for most sexually active Yale women not to enroll in Prescription PLUS.

With fewer enrollees at the healthy end of the scale, the greater financial burden of the chronically ill must be borne largely by them and the University alone, assisted only by those students who are excessively cautious or who forget to opt out each term.

A revamped prescription drug plan could better serve both chronically ill and healthier students. There are several options the administration might consider. The premium could be reduced or, for Ph.D. students, eliminated. Alternatively, the administration might reduce the copay costs to a lower percentage rate or — as other universities do — move from a percentage to a flat-rate system, charging a fixed copay for a month’s worth of prescriptions.

Each of these options would result in a plan that makes more financial sense for healthier students, resulting in greater enrollment. Plus such changes would sharply reduce the extraordinary financial burden currently borne by chronically ill students. Moreover, the expense of insuring chronically ill students would be distributed across a wider population than is currently the case. And each of these options would mitigate Yale’s current policy of outsourcing 20 percent of the cost of treating its HIV-positive students to under-resourced state governments. This is not a small consideration in these times of tight public finances and of popular anxiety that rich universities are unduly hoarding their endowments.

Each option presents its own strengths and weaknesses, each of which should be debated in more detail. But any of these would improve upon the current Prescription PLUS plan, which serves almost no one very well.

Michael Yarbrough is a fourth-year graduate student in the Sociology Department.

Comments

  • Anonymous

    As a "healthier grad student" I completely agree. Yale's health care package definitely needs reworking, especially for Ph.D. students (who, contrary to some comments posted on the YDN lately, really are more like employees than students; no offense, masters students.)

    With the recent opinion articles printed regarding the dental plan, the Prescription Plus plan should also be reconsidered.
    I know that our departments are "represented" in the GPSS (sorry, the elections are a joke), but perhaps there should be a town hall meeting held through GPSS with Dean Butler and others involved. This is a serious issue that should concern all graduate students.

  • Yale 09

    You could investigate other private health care and prescription drug plans.

    OR

    Maybe someone with HIV shouldn't chose a career path that requires them to be in school for the greater part of a decade earning stipends instead of a legitimate salary.

    Yale grad students are spoiled children who go on 6 year vacations in HGS.

    We are supposed to pity them? I think not.

    Life is full of tough choices and trade-offs.

    Join the rest of the country.

  • Annoyed by small-minded ignorance

    Yale 09 - Seeing that you are currently an undergrad here, I highly doubt that you have had any life experiences that have taught you about life's "tough choices and trade-offs" that you so judgmentally speak about. That being said, you obviously have no clue what diverse backgrounds graduate students here come from and a true lack of respect for academia if you have the audacity to say that "Yale grad students are spoiled children who go on 6 year vacations in HGS."

    Finally, whether or not a person has HIV should not dictate their life choices and limit the aspirations they may have for their life. That type of small-mindedness truly shows how ignorant you really are.

  • Yale 09

    You are asking other people to help you escape reality.

    Guess what? The author has HIV.

    Why should that be Yale's responsibility?

    Because he decided to take a 6 year vacation in Sterling Memorial Library?

    Give me a break.

    Entitlement, Entitlement, Entitlement.

    Maybe he should get a real job to pay for his medicine!

    No, that would be MEAN! Let's make Yale pay for it!

    No, wait! Let's have Obama the Magic President give him all the free drugs he wants!

    Wahoo!!

    Yay! It's Christmas everyday for liberals at Yale! Everybody gets whats on their wish list!

    Children

  • Anonymous

    Thank you, Richard, for explaining the problem so eloquently. I am a PhD student who came back to school after a long time in a previous career, where I had full health care benefits. I, too, live with HIV. I knew that I wanted to change careers, because I was sure that I could contribute more to society that way, and I knew that I needed professional training to do so. I checked carefully before I ditched my old career to make sure that I could get some kind of health care. My life does not feel like a "6-year vacation." My workload is heavier than it was when I had my previous full-time job. I am not complaining, just explaining a bit of what graduate school means. We and out families make immense sacrifices so that we can get the skills and knowledge to serve society as professionals when we get out. The enormous wastes of time and the threat of going without required doses because of somebody's mistake in an overcomplicated (top-heavy and expensive) system -- I live those nightmares all the time as well. Like our nation as a whole, the Yale community needs to talk seriously about how to reform our prescription health plan -- and then to take action. Your ideas for reform are an excellent start.

  • Scather

    This just goes to show that when the costs of keeping a population healthy are disproportionately placed upon the most ill, everyone is worse off in the end. In most developed countries the idea of choosing between not dying from Aids-related illness and pursuing an academic path to better oneself as an individual and contributing member of society would be seen as ludicrous and dangerously immoral. One would think people like Yale 09, who obviously prizes his or her individualism above all other considerations, would not want an illness to stand in the way of his or her aspirations. Condemning someone with HIV to a life of just-getting-by and being unable to pursue goals that benefit himself and society seems to me contrary to both the individualist ethos Yale 09 seems to cling to, as well as to anyone who values fairness and prosperity for individuals and our society.

    Yale, thousands of other organizations, and our government need to figure out how to evenly spread the costs and benefits of health care so that the poor and most ill don't face being treated like pariahs. Yale is not responsible for anyone being ill, but by offering health insurance they take on the responsibility of paying to keep people well.

  • why

    Why should anyone except the individual have to take responsbility for his health?

    Family, friends, companies, schools are certainly free to provide extra care.

    But they are not the primary care-givers.

    The individual must take responsibility.

    If I have bronchitis, I won't try to climb Mount Everest.

    If I have AIDs, I won't become a career student without first securing independent medical care.

    The writer is irresponsible on multiple levels.

    But then again- he is a sociology student. What should we expect?