A presentation that was given in December 2019 by Zannah Herridge-Meyer, Kelly Stewart, and Melanie Langa based on an internal survey they conducted on the insurance status of current medical students.

1. THE STATUS OF HEALTH
INSURANCE:
THE UNIVERSITY OFWASHINGTON
SCHOOL OF MEDICINE
2019 Survey Results
Compiled & Presented by:
Zannah Herridge-Meyer, Kelly Stewart, Melanie
Langa

2. OBJECTIVES
Characterize current health insurance
status of UWSOM students
Capture student understanding and
concerns about coverage during clerkships
Share student narratives and experiences
around health insurance
Spur action towards more comprehensive
and affordable health insurance options

3. SURVEY DEMOGRAPHICS
WHO RESPONDED?
Total: 202 Students*
Alaska: 4.5%
Idaho: 8.4%
Montana: 8.9%
Seattle: 47.5%
Spokane: 28.7%
Wyoming: 2%
Foundations (MS1/2): 58%
Patient Care/E & F (MS3/4): 38%
Expanded: 4%
*Margin of error of 6.2% with CI of 95%.

4. CURRENT INSURANCE
ALL STUDENTS ALL SITES
1%
32%
7%
5%
5%
50%
Other
Parent or Spouse
School / Work
Private
Uninsured
State Sponsored
WHAT ABOUT
INDIVIDUAL SITES?
This distribution was consistent at
all campuses except for Idaho and
Wyoming
WHAT ISYOUR CURRENT
MEDICAL INSURANCE
STATUS?

5. MEDICAID EXPANSION BY STATE
Kaiser Family Foundation, 2019

6. WOULDYOUR CURRENT
INSURANCE COVER EXPENSES
INCURRED OUT OF STATE?
Only 21% of current students hold
insurance that provides
comprehensive medical coverage
across state lines
PRE-CLERKSHIP COVERAGE
(MS1, MS2, CE ALL SITES)
6%
16%
3%
21%
29%
25%
Did not answer
Yes - Emergencies only
Out of network or limited network
Yes - full comprehensize
I don't know
No

7. Student Stories:
Coverage
■ "I did have an out of state emergency room visit my second
year while I was still on my parents' private insurance (PPO)
and they covered absolutely none of my ED bill (ended up
being ~$11k) ... I've told this story to other students and few
have any idea that your emergencies may not be covered at
all.” - MS4
■ "I lost my parents insurance right before clinical rotations
started, and it has been a struggle to maintain coverage for
my chronic medical condition. I recently lost Medicaid briefly
due to my spouse having an internship and the
added income. [I] went three weeks without medication
because I had no other options. I would love to know
what other people are doing to be covered during rotations.”
- MS3
■ “It is awful not having school-covered insurance. Basically it
is a fortune for nothing. I get only one free doc visit per year
with mine and otherwise my deductible is too high for me to
ever reach it.” - MS4

8. COVERAGE DURING CLERKSHIPS
(MS3, MS4)
2.0%
3.0%
7.5%
4.5%
15.0%
20.0%
48.0%
Yes, I Changed Medicaid in every state
I don't Know
Did Not Answer
Limited Network
Yes, I was covered
Emergency Only
No, I was not covered
WHILE ON ROTATIONS, DIDYOU
CARRY MEDICAL INSRUANCE
THAT WOULD COVER EXPENSES
INCURREDWHILE OUT OF
STATE?
CLINICAL STUDENTS
ARETAKING ON
SIGNIFICANT
MEDICAL
AND FINANCIAL RISK
68% of students carried
inadequate or emergency only
health insurance while on
rotations out of state

9. Student Stories:
Medications
■ “One specific concern I have about having WA
Medicaid is the inability to fill prescriptions
(particularly for expensive, specialty medications)
while out of state. Medicaid requires many specialty
meds to be filled by a mail-order pharmacy and these
shipments can only be received at WA addresses and
someone must be available to sign for the package.” -
MS2
■ "I do have a couple of asthma meds that are refilled
every 1-2 months (depending on the prescription)
and it's super annoying that I have to have a friend in
WA fill them and then mail them to me inWWAMI
land because otherwise I'm paying full price out of
pocket without prescription insurance coverage.” -
MS3
■ "It has been an incredibly challenging process to start
up the insurance and obtain the prescriptions and
medical supplies I need for my type 1 diabetes." -
MS1

10. PLANNING FOR CLERKSHIP
COVERAGE (MS1, MS2, CE, MS3 who have not left the
state yet) 6%
25%
38%
17%
3%
2% 1%1%
I plan to be uninsured
I plan to pay OOP for expenses incurred
while out of state
I do not have a plan
My current private plan will cover my
expenses
SHIP will cover me
Purchase Travel Insurance
Purchase Private comprehensive plan
I will keep VA coverage
STUDENTS DON’T
KNOWWHATTO
DO
69% of students have not
planned for insurance
coverage out of state, or
plan to pay out of pocket
for expenses incurred while
out of state
WHAT ISYOUR PLAN FOR HEALTH
INSURANCEWHENYOU GO OUT OF
STATE?

11. Student Stories:
Planning
■ “Eventually decided that cost concerns
with generally healthy self made going
uninsured the best option... certainly not
the safest.” - MS4
■ "So far, I have traveled out of state for
one rotation. I completed all health
maintenance care prior to leaving, but
was reassured that emergency services
would be covered by Medicaid. I imagine
this wouldn’t have been possible if I had
greater healthcare needs.” - MS3

12. PRE CLINICALVS. CLINICAL STUDENTS
0%
5%
10%
15%
20%
25%
30%
I don't know No Yes - full
comprehensize
Yes -
Emergencies
only
Limited Network
(VA, SHIP etc)
Did not answer
PercentofRespondents WOULDYOUR CURRENT INSURANCE COVER EXPENSES
INCURRED OUT OF STATE?
Light: Pre-Clinical Darker : Clinical
DO STUDENTS
CHANGE
INSURANCE
DURING
CLERKSHIPS?
There is no significant
difference between the
types of insurance plans held by
pre-clinical and clinical students.

13. ARE MS2s PREPARING FOR CLERKSHIPS?
0%
5%
10%
15%
20%
25%
30%
I don't know No yes, Full
Comprehensive
Yes, but
Emergency Only
Limited network
(VA, SHIP)
Did not answer
PercentofRespondents
WOULDYOUR CURRENT INSURANCE COVER EXPENSES
INCURRED OUT OF STATE?
Light: MS1 Darker : MS2
MS2 STUDENTS DO
WILL NOT BE
COVERED OUT OF
STATE
MS2 students carry insurance
with worse out of state
coverage than MS1 students,
despite targeted
communication from UWSOM

14. Student Stories:
Future Directions
■ "It would be extremely helpful if the school
offered some kind of option for even just
the out of state portions of our education."
- MS2
■ "I am very concerned about this. If as part of
our program we are required to go out of
state, the school needs to have a plan to
make sure we are covered. It is not enough
to say that we should get appointments
before we go or fill our medications.That is
assuming a lot about the students. Some
students have chronic conditions that need
close follow up. Some students have
regular medications that they should have
access to.We are also around sick people
and our risks are higher.Time to figure out a
plan.” - MS2
■ “The school should either provide an
insurance option… or greater flexibility and
support for those who need to stay in their
home state for health reasons.The burden
should not be on the student." - MS4

15. NEXT STEPS
Connect
Connect students to share
stories best practices and
clarify recommendations
Outline
Outline state-specific
resources (medicaid
expansion) available for
students including
LifeFlight/other additional
insurance benefits
Develop
Investigate insurance
options and provide
students with enough
information to make
informed decisions about
risk vs coverage
Provide
Provide comprehensive
health insurance for all
students