URMIA Matters
URMIA Matters
Student Healthcare Changes for 2025 and Beyond
Join guest host Michelle Smith, URMIA’s Executive Director, as she interviews Liebe Meier Swain from Cornell University and Phillip Arrington from HUB International, who discuss how access to healthcare, especially mental health services, is linked to higher graduation rates. They highlight legislative changes, including Medicaid cuts and Affordable Care Act revisions, which may disproportionately affect vulnerable student populations, particularly those in rural areas and on Medicaid. They emphasize the need for campus-wide collaboration, proactive planning, and financial literacy to support students amid rising healthcare costs and shifting policies. Explore the evolving landscape of student health insurance and its critical role in student success in this episode of URMIA Matters.
Show Notes
ACHA - American College Health Association
American Council on Education Healthcare Issue Landing Page
AAU, Associations Raise Concerns on Proposed Medicaid Cuts
Guests
Liebe Meier Swain, Director, Student Health Plan - Cornell University
Phillip Arrington, Vice President, Campus Health Solutions and SHIP Segment Leader - Hub International
Guest Host
Michelle Smith, Executive Director - URMIA
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URMIA Matters: Student Health Insurance Changes Transcript
Jenny Whittington: [00:00:00] Hey there. Thanks for tuning in to URMIA Matters, a podcast about higher education, risk management, and insurance. Let's get to it.
Michelle Smith: Well, hello, everyone. And welcome to another edition of URMIA Matters. My name's Michelle Smith, the Executive Director at URMIA. And it is my pleasure to have two guests to talk about a very important topic, especially as we're recording this, students are heading back to campus. Things have already geared up at Indiana University with today being the first day of class and our first home football game this weekend. So, there's quite a lot of buzz here. I'm gonna ask each of our guests to introduce themselves today. We have Liebe Swain from Cornell University who joins us and a partner in addressing risk on campus, Phillip Arrington at Hub International. And we're gonna talk about healthcare and the [00:01:00] impact that college students are feeling in 25 and beyond, and how our risk managers can help prepare their institutions for the changes that are coming up or may already be feeling. So, Liebe, do you mind introducing yourself to the URMIA Matters audience?
Liebe Meier Swain: Yeah, sounds good. Thank you so much, Michelle and URMIA, for having me here today. Really excited to be here. So, as Michelle said, I'm Liebe Meier. I'm the Director for the Office of Student Health Benefits at Cornell University, and I am a part of this conversation today because I've spent the last 20 years in healthcare and I think there's so much movement happening within the student space that there's a lot of potential for really good health policy and opportunities to really shape how our emerging adults and leaders view health, health insurance, health and wellbeing, and the fundamental roles that our campuses have in establishing some of these, these [00:02:00] beginning.
Michelle Smith: Super. Thank you for that, that focus. And Phillip, tell us a little bit about yourself.
Phillip Arrington: Yes. Phillip Arrington, Vice President at Hub International. I lead our student health insurance segment and I've, I've actually spent almost my entire career in the student health space. And why this subject is important to me, early in my career, I spent considerable amount of time on the Affordable Care Act and the effects on students, student health, student health insurance. That was 2010 to 2013. And now we're, we're moving in a opposite direction with some of the new legislation that's been passed. And I think it's important to get this information out, so decisions can be made appropriately for students.
Michelle Smith: Great. Thank you. And I think probably just, you know, getting into the meat of the conversation, why are we having this conversation, you know, why is student access to healthcare [00:03:00] important to an institution? And, and maybe we can lob that over to you, Liebe.
Liebe Meier Swain: Yeah, certainly. Thanks so much. So, one of the things that we are finding within the American College Health Association, so this is the sort of leading college organizational body around student health, student wellbeing, is that schools that have an insurance requirement are experiencing a corollary in terms of, an improved corollary, in terms of completion rates and, and meaning graduation rates. Right. So, in 2022, the ACHA Coalition for Student Health Insurance Benefit Plans did a survey of its ACHA members, which is roughly 700 members or so. We had 235 responses to this survey. We found that for those schools, either public or private, that had an insurance requirement, those students were completing or graduating on time, [00:04:00] about 20 percentage points higher than students or schools without an insurance requirement.
We know that many students need access to mental health care and wellbeing over, you know, 35% of claims data on a college population will show you that mental health care and wellbeing is extremely important. And so, not all campuses are equipped or able to provide routine long-term mental health care and resources. Often their counseling and psychological services departments are equipped to provide acute care and intervention, but students need to go out to the community usually in order to have a long-term therapeutic relationship or ongoing mental health care relationship. So, this is why this is important. About 23% of all of the, you know, just over, what is it, [00:05:00] 6,000 colleges and IEGS, institutions of higher education in the United States. About 23% of those schools have a student health insurance plan, and more of those schools would have an insurance requirement. So again, we're seeing this as really fundamental to a student completing their degree on time and successfully.
Michelle Smith: Yeah. ACHA is a sister association to URMIA. I've, I've seen these statistics from their team and their executive director in particular, and really important group to make sure is on your right, your radar and your, your mental health staff radar and, and student success staff radar as well. I mean, it, it's more than just an, an acute treatment issue. We're hearing that from our K-12 members that they're seeing it. And so, obviously, it's gonna, it's gonna step foot on campus as these [00:06:00] students move forward. So, beyond the immediate need, what else does a decrease in access to healthcare due to our students?
Liebe Meier Swain: Yeah, so it's, I mean, it's complicated. Yay healthcare. It's complicated. One of the things that I would say another organization that many schools and universities work closely with is the JED Foundation. You may be familiar that their mission is to protect emotional health and prevent suicide for our teens and young adults. And through the JED Foundation, they report that roughly 18% of teens between 12 to 17 have had a major depressive episode, and within the past year, this is a 2024 study, and that over 40% of high school students report persistence, persistent feelings of anger or sadness or hopelessness. And this is, this is impacting so many groups, and subgroups, within our teens and adolescents, [00:07:00] females, LGBTQ+ communities, black students, American Indian, Alaskan Native. Everybody has experiences. Many people experience an increase in mental health concerns, needs, and wanting support. It's not uncommon to need health and support.
Just as you were saying earlier, our K-12 population, one of the things within student insurance and student health that we're really starting to look at is the K-12 environment and understanding better some of the healthcare and learning needs and issues coming forward. Because many of those individuals will, at some point, land on our college doorsteps and how are we prepared to serve them and meet them where they are? So, the whole crux in all of this, so students’ access to healthcare. We also, so we think about often students that [00:08:00] are, we assume that students are insured via their parents, except that nationally Medicaid is actually the single largest payer of mental health resources in the United States. So, in the current climate where there have been proposed substantial changes to Medicare access and coverage, this becomes a bigger issue.
So, we've seen where in areas where severe mental health illnesses or crises, that there is a potential increase for death by suicide or other unfortunate and extenuating circumstances. This is why student health insurance is important. This is why some of the mental health resources are important. And again, really about, I think it's 13, Phil, you might have to help me out here, 13 to 15% of college students are on Medicaid. So, this is not like an anomalous pair [00:09:00] on any campus, right? Doesn't matter if you're an Ivy League, Big 10, you know, small university, small college, youth students with Medicaid access, and it's appropriate for them. But if they now have decreased resources, how are they going to be successful?
Michelle Smith: That's a great point. And maybe we'll flip to Phillip as with a follow up on that. So, there's obviously changes happening. We aren't burying our head in the sand. We know that changes are afoot for both Medicaid and, and ACA. And as renewal come due in the top of the year, what can the students expect to see? What can the families who are helping these students, or the faculty and staff who are advising these students, and what can we expect to see? What's the change?
Phillip Arrington: Yeah. First to, to build on what Liebe was saying, but fortunately, there was a government accountability office report that came out this past March that broke out where college [00:10:00] university students, the 19, almost 20 million college and university students are getting their access to healthcare, their health insurance, Medicaid. Whatever it is. And what they found was that 13% of college and university students are on Medicaid as of 2022. Prior to this, and going back to 2010 to 2013, when I was talking quite a bit about the implementation of the Affordable Care Act, and the Medicaid expansion. If you go back to 2010, that number was 7%. So, there are roughly 6% of college and university students that have gained coverage through Medicaid since 2010. That's equivalent to over 1 million college students. So, when we talk about a number, it's significant.
Shifting over to the One Big Beautiful Bill Act that was passed and signed into law this past July 4th, they're looking to cut $911 billion from Medicaid in many various [00:11:00] different ways. And, and we'll get into that in just a moment overall, and their, their various estimates. But the CBO estimates that 10 million people overall will lose Medicaid. So, how are they doing that? How are they reducing that number? First, they're limiting non-citizens’ eligibility for Medicaid. Medicaid will limit payments to facilities who perform abortions for one year, and there are some exceptions around that. Very interesting caveat to the bill. They're increasing cost sharing, so up to a $35 copay where it may have been low or no copay prior. And then the big piece, and you're probably hearing this on the news, are the work requirements. And we say work requirements, there are waivers if you are a, a college or university student taking at least 12 credit hours. So, digging into that, there are a lot of question marks about, what about the summer? What about if a student takes a semester off where they're traveling abroad or. Or some other reason, [00:12:00] medical leave of absence, how would that work? But there is a waiver.
And to dig into that a little bit further, there's, there's one big piece to this. A, a student would have to become eligible twice a year, prove their eligibility. That could actually be monthly depending on the state. So, they're consistently being asked to prove they're going to school or working, and I think there's a big question mark around will college or university students actually do that? Really the only comparison we have to try to predict the future and what will happen is in 2018, Arkansas implemented a similar work requirement, and it resulted in 25% of individuals subject to the work requirement, losing coverage. Even though a majority of those recipients would've qualified for an exemption. So, we're seeing a large percent of individuals that would be able to exempt themselves from this work requirement, this school requirement that, you know, did not meet those requirements, did not submit their [00:13:00] paperwork, or submitted it incorrectly, and we very well could see that in the upcoming implementation.
Liebe Meier Swain: This is big, Michelle. So, for any school who does like an insurance waiver process, inevitably they're faced with at the end of the waiver season, you know, the insurance waiver season where they're showing that they have healthcare. Many phone calls that are like, but I forgot, or this happened, or that happened. Okay. And schools have leniency, and I do not anticipate the same leniency happening with Medicaid to be super frank. Right? And it becomes a real issue if you lose coverage, and then what? Like how are you getting coverage? What is your, you know, uninsured and underinsured really becomes the big problem here.
Michelle Smith: Just another round of barriers to basic universal healthcare. It just seems the minimum amount of things that you'll have to do to gain this access. Obviously, the onus is on the student and the family, however, schools are gonna be trying to catch up with these [00:14:00] things, as you mentioned as well. Which is time and money that they're asking us to do away with and cut and reduce. And so, doing more with less, again seems to be the cadence here. So, how do we, you know, how do we expect this to impact schools that have that high percentage of students who are using this kind of coverage? I would guess community colleges and rural campuses are, are probably gonna be impacted more. So, 12 credit hours, for example. You know, I have a full-time job and children, and I can only take 10 hours, but I need that coverage. So, yet another barrier. Who do we expect to be impacted the most?
Phillip Arrington: Yeah. I'll toss this over to Liebe. I know you, you've done quite a bit of research on how rural providers and hospitals will be impacted and what's the impact on colleges and universities that may be in, in more rural [00:15:00] areas. Not too dissimilar from Cornell, which is in a relatively rural area of New York
Liebe Meier Swain: That's really isolated, right? Like, you know, we have one hospital in our county. And so, in rural areas, roughly 18% of adults are in a rural area. or designated rural area, and roughly 20% of American students attend schools or universities in one of these areas. Again, you know, just Cornell being an, an example. One of the things that's true is that when there's a decrease in federal payers, you know, federal funds, repaying hospitals or paying hospitals for services. Then you have those hospitals trying to squeeze or increase the premium price, increase the cost of services that commercial insurances, or the exchanges or an employer sponsored plan end up paying. And so [00:16:00] then that has a trickle effect for increased insurance rates. You can see this in the market coming forward already. Kaiser Family Foundation has put out a lot of really good early assumptions of what some of the renewals might look like in the coming year.
And so, if you've got Medicaid cuts resulting in about a 15% decrease in rural hospital payments, those communities, then similarly, they have to balance out some way, right? And so, are we going to now add 15% cost to the commercial or self-pay environment? Maybe, maybe not. Or maybe you just have more bad debt happening at a hospital. You've got more hospitals, already it's difficult for hospitals to, to thrive. Most of them at a nonprofit organization are cutting even at zero, right? Like these are not, you know, cash, large cash flow organizations. And so, it, it just, it continues to [00:17:00] squeeze. I think somebody referred to healthcare a lot like a balloon, right? You squeeze in one area and you're going to expand someplace else. And so, the expansion here is not to the benefit of others. That's the hard piece in this analogy.
Michelle Smith: Yeah, and I feel like there's more than just, you know, the basic healthcare. I mean, you get treated, great, but there's gonna be some next step, right? There's gonna be some testing, there's gonna be prescription, those sort of things. Do we expect an impact in this area as well? Phillip?
Phillip Arrington: Yes, and around prescription drug pricing, there have been a lot of changes occurring. And this is probably going to be one of the hardest predict what is actually going to happen. There were two executive orders that were signed over the past six months, one of which removed the previous administration's executive order that allowed health and human services to negotiate Medicare drug prices. Of course, that would trickle down to other insurance companies, other payers, and then they capped generic copayments at [00:18:00] $2. This new executive order that was signed in May introduced a most favored nation pricing, so trying to align US drug prices with other countries. There is some data out there that in other countries they do pay less for pharmaceuticals than they do in the US and it'll be interesting to see how that plays out.
I think the biggest wild card, if you will, are tariffs. And how could this lead to higher pharmaceutical costs? So, a great example is that the, I think, I believe it's a 15% tariff on EU pharmaceuticals. And some of the pharmaceuticals they provide predominantly are GLP-1s, which is an over trillion-dollar industry. Now, quite a few individuals are, are taking these types of medications with great outcomes. And cancer medications. So, will we be paying more for certain medications based on the tariff [00:19:00] of the country they're from? Or will the executive order with most favored nation pricing come into play? So, it will be interesting to watch some of those changes, but I think it's worth mentioning that roughly a third of healthcare spend in America is on prescription drugs. So, this really could move the needle depending on if it increases prices or decreases prices. Hopefully, it's the latter.
Liebe Meier Swain: And it's not just student health plans, right? So even employer plans are gonna be going through this. And in particular in an employer population, you have a greater use of GLP-1s. But that isn't to say that GLP-1s aren't being used in the student realm as well for, you know, treatment of diabetes as an example. There is a lot of unknown, and all of everybody's insurance rate is based off of what your experience actually is, right? So, you can't, you can't just make up a number. You know, that's not how the State Department of Insurances work, but [00:20:00] you know, you have to prove that this is really what's happening. And so, the timing of all of these, you know, may or may not be felt in this coming year or the year after. And so, really, what's the multi-year strategy around an ensuring and protecting student health and wellbeing?
Michelle Smith: Exactly. It makes the budgeting exercise a little devious. And, you know, it seems to be a constant, things are in constant flux. There's constant change. But, but do we anticipate sort of a, a rollout date, target date? Or is this something we just should be prepared for and run the exercises and the, the numbers. And scenarios year after year or every six months or. What advice do you have on that?
Phillip Arrington: Yeah, as I had mentioned, the bill was recently passed last month, July 4th. The One Big Beautiful Bill act was signed into law and it's moving quickly. So, the Medicaid cuts begin 1 of next year. [00:21:00] So, we're talking, you know, less than half a year. We will start to see the impact. The Medicaid school work requirements those don't begin until the end of next year. But again, that's breakneck speed for an implementation of a new law. And then some of the Affordable Care Act changes, those begin at the beginning of the year as well. And some of those will be significant as well for the populations that do get their coverage from the state and federal exchanges.
Liebe Meier Swain: Yeah, I mean I think that one, the afford, changes on the Affordable Care Act and the health exchange is something that'll impact not only just students, but students and their families. Similarly, Medicaid is also, right, it's based off of household size and income, and so if you know working parents not able to meet the requirement, that's insurance for everybody that's now in jeopardy. It's not, you know, oh well this person didn't make it, but the rest of the household can stay on coverage. And you know, students as they're going, or families as they're navigating the exchanges, the pricing of it, I [00:22:00] think, Phil, isn't it that the tax subsidies are coming off, which is one of the things that puts the health exchange as a less viable option going forward.
Phillip Arrington: Yes. So, there were some enhanced subsidies that were rolled out around 2021, I believe, during the Global Pandemic. And those are going away. Those are not being renewed. They were set to be renewed at the end of this, this year, it would've had to be already done. So, those aren't renewing, and the impact is significant. So, 22 million people receive these premium tax credits, subsidies. And with those going away, they're anticipating for those individuals that their costs could rise, their out-of-pocket premium costs could rise on average, 75%. So, you're seeing a significant upswing in the cost of an Affordable Care Act plan, which has an impact for students. It's less than 1% of college students, according to that GAAL [00:23:00] report that do get coverage from the state or federal exchange. But that's still an impact. And 1% of 20 million is still not a small number. There's also some changes around special enrollment periods. Back in February, we removed all but 10% of the funding for healthcare navigators. So, if you think of a college student looking for coverage and you know, perhaps their university does not offer a student health plan, they would go to a healthcare exchange navigator. Well, they probably won't be there any longer, so there's quite a few changes around that as well.
Michelle Smith: Yeah, many changes. More barriers, higher costs. Seems unlikely this is gonna get better before it gets worse for, for our students and their families. But what do risk managers do? What, what are some practical steps that our risk managers can do to prepare their campuses and their institutions, their leadership for these changes?
Liebe Meier Swain: So, I think one of the [00:24:00] things that's really true among college students, you know, insurance, there was a recent survey that insurance is scary, right? They're like, I don't know what this thing is or what it does or what I'm supposed to be doing with it. And so, it's not, I think the job of risk managers and our partners is, is coming at, at things more from an eyes wide open sort of standpoint, right? The number of students, or you know, how well do risk managers and others understand the number of times a student is asking for emergency funds to pay for medical care? Because that's going up substantially. You know, out of pocket costs. You, you know, if you are hearing a student saying, I can't go, you know, to the doctor, or I can't afford this copay, because I need to be in class or I need like. There are more juggling. There's more juggling that's going to happen. I think that, you know, understanding what exec, if your school, if your university offers a student health insurance plan, understanding what's in that plan, and [00:25:00] what benefits are being offered, and how well the institution can continue to support those benefits at the lowest possible cost.
Making sure that there's still an insurance requirement. I think this is not the time to say, okay, we're gonna get out of, you know, asking people if they have health insurance. I actually think that it's knowing more people need health insurance, so how do you support without being punitive? And you know, because I think through this conversation, we, we've been trying to indicate that health insurance is really key to student success, and that's all we wanna do, right? See students succeed. We're in the job of making and supporting students. So, working with, you know, campus partners, you know, your AVP of Health and Wellbeing, or your dean of students, first gen programs, connecting with all of those points where it might be easy for somebody to slip through because they don't have as much knowledge. You know, leaning into other resources. URMIA, ACHA. There are a lot [00:26:00] of consultants in the student health and insurance space. Talking to your carrier. Being aware of, you know, even just sort of your own liability policies.
And if you're seeing an uptick in, you know, general sort of like trip and falls, right? Because when folks don't have health insurance, some of those claims tend to rise because it's the only place that they're able to get care. And so, it really, I think there's a bit of a grassroots effort that's really needed, and having resources, and this is asking a lot, right? Because all of our institutions have to do more with less. That is clearly the environment that we're in. And what are, you know, simple things or sometimes small things that you, that your college/university can do to aid in stress reduction, risk reduction, and really being a partner with your other college health, student health experts in, in this space. Phil, other [00:27:00] ways to make it better? Make it more supported?
Phillip Arrington: I think you nailed it, Liebe. I mean, we're looking at, you know, nearly one in five college students that are looking at the prospects of their financial means to accessing healthcare, potentially going away. And I, I can't emphasize how critical the next six months to a year will be for universities that are prepared. And you will see universities that are not prepared for this change scrambling, as students are coming to campus or they need healthcare, and they don't have that financial means to accessing healthcare. So, to your point, just really having those conversations on campus I think will be critical.
Liebe Meier Swain: And I think the other folks that are involved too is like financial aid and alumni affairs. And the reason that I say this is that, you know, depending on what your cost of attendance package is, like health insurance may or may not be something that you can add into your cost of attendance. And we also know that the act that just passed in July limits the caps on [00:28:00] federal grant aid. So, you know, making a student choose between being able to get a decent meal, you know, food package meal and housing package, and then how do I get insurance too, right? Like, that's not an ideal environment, but I think it's gonna take a lot of collective thinking and conversations and being willing to say, Hey, I, I don't know how this is gonna work. What's it like in our population? Who's asking for help? You know, how well are we positioned to offer additional help? And if we can't, what is mission critical around student health?
Michelle Smith: Yeah, so many good points. And just an icing on the cake and an exclamation point for the cross-campus collaboration that we talk about here at URMIA. And thank you so much, Liebe, for being such a great partner on Cornell's campus to our risk manager there. We appreciate that. You know, it just underscores all the points that, and the good work that our student affairs partners are doing and our res hall staff is doing. [00:29:00] As, as those folks who interface with the students directly on a daily basis and underscores the need for financial literacy and understanding insurance as part of that, and in preparation for good old adulting once they, they get out of school as well. So, you know what an important conversation. And really appreciate you both taking the time to, to be on air with us for this episode of URMIA Matters and bringing this to the forefront of our minds as students head back to campus and families prepare for this, this milestone and, and this next journey and their, their students' lives. So, thank you both, Phil, Liebe, for being with us today. We really appreciate it, and we invite our members to engage in the conversation and ask questions. We’ll include Phil and Liebe’s contact information in our show notes to brush up on this skill and, and make sure that our campuses are as good as they possibly can be. So, thank you. This wraps another episode of URMIA Matters. [00:30:00]
Liebe Meier Swain: Thank you.
Phillip Arrington: Thank you, Michelle.
Narrator: You've been listening to URMIA Matters. You can find more information about URMIA at www.urmia.org. For more information about this episode, check out the show notes available to URMIA members in Theia Network Library.
