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<DIV style="FONT: 10pt arial">----- Original Message -----
<DIV style="BACKGROUND: #e4e4e4; font-color: black"><B>From:</B> <A
title=lvpsf@igc.org href="mailto:lvpsf@igc.org">Steve Zeltzer</A> </DIV>
<DIV><B>To:</B> <A title=Undisclosed-recipients:
href="mailto:Undisclosed-recipients:">Undisclosed-recipients:</A> </DIV>
<DIV><B>Sent:</B> Wednesday, January 30, 2013 11:10 AM</DIV>
<DIV><B>Subject:</B> Obamacare loophole threatens UC students</DIV></DIV>
<DIV><BR></DIV>Obamacare loophole threatens UC students<BR>Nanette Asimov and
Victoria Colliver<BR>Updated 11:02 pm, Tuesday, January 29, 2013
<DIV><A
href="http://www.sfgate.com/health/article/Obamacare-loophole-threatens-UC-students-4234269.php">http://www.sfgate.com/health/article/Obamacare-loophole-threatens-UC-students-4234269.php</A><BR><SPAN
style="FONT-SIZE: 12px" class=Apple-style-span><BR></SPAN>
<DIV><SPAN style="WHITE-SPACE: pre" class=Apple-tab-span></SPAN>• <IMG
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id=sfgate-photo-4106800
alt="Kenya Wheeler talks to Malla Hadley, a manager at the Department of City and Regional Planning at UC Berkeley, about how he can resume his studies, which had to be postponed during cancer treatment. Photo: Sean Havey, The Chronicle"
src="cid:F7FAC3861AC84AABB767C1E9E7C394CA@owneryr3fp4mcb" width=628 height=418
apple-height="yes" apple-width="yes"><BR>Kenya Wheeler talks to Malla Hadley, a
manager at the Department of City and Regional Planning at UC Berkeley,
about how he can resume his studies, which had to be postponed during cancer
treatment. Photo: Sean Havey, The Chronicle<BR></DIV>
<DIV><SPAN style="WHITE-SPACE: pre" class=Apple-tab-span></SPAN></DIV><IMG
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src="cid:97C93548B41F4DEF9F5B33D10764BBA0@owneryr3fp4mcb" width=15 height=15
apple-height="yes" apple-width="yes">Life was great for Kenya Wheeler
in the spring of 2011. He'd just enrolled in a UC Berkeley master's
program in city planning and had won a research position that would
pay his fees. Healthy as a horse, he biked to campus every
day.<BR><BR>A year later, a cancer diagnosis had changed everything.
Wheeler, 38, had so many medical bills that he reached the $400,000
limit allowed by his UC student health plan. He scheduled a hasty wedding with
his girlfriend in March so he could continue receiving life-saving
chemotherapy through her insurance.<BR><BR>"I didn't know when I was diagnosed
that I would be in for a battle to fight my cancer - and for my medical care,"
Wheeler told the UC regents at this month's meeting in San
Francisco.<BR><BR>Health care limits like the one imposed by UC are already
illegal under the sweeping federal health-care law - dubbed Obamacare
- that takes full effect next Jan. 1. But the health care act does not
apply to "self-funded" college plans like UC's, in which
the university takes on the financial risk of medical claims.<BR><BR>Now,
thousands of UC students are demanding through a petition drive that the
university voluntarily lift its insurance caps.<BR><BR>"There's a loophole in
Obamacare that exempts (self-funded) student health plans," doctoral
student Charlie Eaton of the UC Student Employees
Union told the regents. "We ask you to voluntarily drop the caps this year.
We don't want anyone to have to go through what Kenya has gone
through."<BR><BR>UC officials say they're weighing their options but are
hesitant to voluntarily lift the caps until they know what it would cost -
and how much they'd have to raise the price of student health care to pay
for it.<BR><BR>"It's a front-burner issue," said Peter Taylor, UC's chief
financial officer, who became aware of the problem last summer. "We're
not making a profit on (student health care) - but I can't afford to lose
money, either."<BR><BR>Self-funding benefits<BR>Universities have long offered
student health coverage to make sure their students have access to health care.
Most college health plans purchase a group policy from a health insurance
company and must adhere to the new federal requirements.<BR><BR>But some large
universities - an estimated 30 universities and systems covering some 300,000
students nationwide - prefer self-funded health plans because they provide more
control over policy terms, offer lower taxes and let schools keep funds until
it's time to pay a claim. Similar self-funded plans are offered by
corporations and other large businesses, but they are subject to the
new federal regulations.<BR><BR>It's not clear why self-funded student
policies were left out of the law, but federal health officials indicated last
year they did not believe they had the legal authority to regulate this
type of plan.<BR><BR>Nonetheless, starting Jan. 1, the federal law will require
Americans - including students - to have health insurance that meets
certain minimum requirements or face penalties.<BR><BR>Meanwhile, UC and
other universities, including Harvard, have asked federal health officials to
add self-funded student health plans to the new law, in which case UC would
be required to lift the caps, said Grace Crickette, UC's chief risk
officer. Asked why, Crickette said it was to benefit students, who might
otherwise suffer tax penalties.<BR><BR>"We don't know if we'll get in," she
said. "We might be rejected."<BR><BR>UC switched to a self-funded system in
2011, not long after the federal prohibition on coverage limits took effect in
September 2010.<BR><BR>Most of UC's 10 campuses limit coverage to $400,000.
Students at UCLA pay more for a $600,000 limit, while graduate students
at UC San Diego pay even more for a $750,000 cap. Far lower caps exist for
subsets of coverage, including prescriptions. Wheeler's drug cap -
reached in three months - was $10,000.<BR><BR>He worked for the law<BR>Wheeler,
who grew up in Berkeley, became interested in urban planning in the 1990s after
graduating from UC Santa Cruz with a degree in environmental studies. While
saving money for grad school a few years ago, he became a field director with a
group pushing for passage of the Affordable Care Act - Obamacare - and
celebrated its U.S. Supreme Court victory in June. He never imagined that
two months later he would begin tumbling through a gaping hole in that very
law.<BR><BR>Seizures landed him in the hospital, where doctors diagnosed a brain
cancer called primary T-cell lymphoma of the central nervous system.
Chemotherapy would be so intense that Wheeler would have to be hospitalized for
five days every two weeks throughout the treatment period.<BR><BR>"It was
all covered by the UC Student Health Insurance," said Wheeler, who was seen
at UCSF Medical Center, the flagship hospital of the university
system.<BR><BR>Or so he thought. As his medical and pharmaceutical bills soared
beyond $200,000 in just five months, Wheeler became alarmed. His pharmacy
stopped providing the daily pill he was supposed to take. He had had one pill
left when the drug manufacturer's hardship program finally accepted
him.<BR><BR>"That was a very close call," Wheeler said. He was less lucky
with Medi-Cal, the state-federal health program for the poor,
which rejected him in February.<BR><BR>Girlfriend to the rescue<BR>He and
his girlfriend, Ruby Reid, had been dating since 2009 and dreamed of a
wedding in the Santa Cruz Mountains that would combine romance with fun.
Wheeler had his eye on a package where the wedding party would travel by steam
train through a meadow - and suddenly be held up by train robbers. He, the
groom, would rescue his bride and save the day.<BR><BR>His bride, it turned out,
rescued him.<BR><BR>They married at 4 p.m. March 30 in the meditation room at
UCSF. "Three hours later I was in a bed on the 11th floor getting prepped
for chemo," Wheeler said. And by April 1, he was fully covered under the
insurance of his new wife, the data director for a political action
committee.<BR><BR>Today, his cancer is in remission.<BR><BR>"I'm saddened to see
that students' well-being has to be held in a cost-benefit analysis," Wheeler
reflected. "UC should be giving them the best care, especially since UC
hospitals are some of the best in the nation."<BR><BR>A fix is
needed<BR>UC's Jack Stobo, a physician who serves as senior vice president
of health services, agrees.<BR><BR>"If we have students, particularly of UC and
in UC programs, who can't get the medical care they need and deserve, then shame
on us," he said. "We need to fix that."<BR><BR>At the same time, Stobo said
he knew of only about five cases in which UC students had hit the lifetime cap.
Those who need more insurance might qualify for Medi-Cal under Obamacare's
expanded eligibility requirements, which go into effect next January,
or they could buy coverage through virtual marketplaces known as
"exchanges" that will also be part of the new law, Stobo said.<BR><BR>Another
doctor takes a different view.<BR><BR>No matter how few students reach the
coverage limit, "it shouldn't be that UC exposes them to bankruptcy, incomplete
treatment or death. It's just wrong," said Dr. Flavio Casoy, chief
resident for psychiatry at San Francisco General Hospital, part of UC.
Although his psychiatric patients are unlikely to reach coverage limits,
Casoy thought the issue important enough to take up with the
regents.<BR><BR>"Who can predict when a normal bike accident results in a bad
back injury, which has complications, and the person develops an infection,
and so on," Casoy told the regents. "It's astounding to me how unexpectedly
these bad things happen and how wildly health care costs can spiral
up."<BR><BR>Nanette Asimov and Victoria Colliver are San Francisco Chronicle
staff writers.
E-mail: nasimov@sfchronicle.com, vcolliver@sfchronicle.com<BR><BR><BR><BR>Read
more: http://www.sfgate.com/health/article/Obamacare-loophole-threatens-UC-students-4234269.php#ixzz2JTnaloED</DIV></BODY></HTML>