What College Students Need to Know About Health Care Reform

"We have to pass the bill so you can find out what is in it."

--Nancy Pelosi, Speaker of the House

By Cecilia Bonaduce

Nearly 5 million college students are currently uninsured. Most full-time students do not meet the eligibility requirements for employer-based insurance or (until September, 2010) dependent coverage. For years, college students have been forgotten and excluded from meaningful healthcare policy. Will healthcare reform make coverage more accessible to them?

The Patient Protection and Affordable Care Act (PPACA), signed into law by President Obama on March 23, 2010, initiates a comprehensive healthcare reform geared towards decreasing healthcare costs, expanding coverage and improving government-run public health programs.

Major components of the bill include requiring coverage for all citizens and legal residents, establishing Health Benefit Exchanges, expanding both Medicare and Medicaid, and requirements for “ qualifying coverage.”

Conscription into Healthcare

The new law requires all citizens to obtain health insurance by 2014. Failure to do so will result in an annual charge of $95 dollars, an amount that will increase seven-fold over the following two years, or 2.5% of taxable income (whichever is greater). Without affordable healthcare plans, students will have difficulty complying. PPACA attempts to make coverage accessible to young adults. But whether these measures are sufficient is yet to be determined.

For example, even if coverage options are available to college students, it is unclear whether the negative incentives are sufficient to motivate all students to seek coverage. For Cal students, having some form of qualifying insurance (e.g., a student health plan (SHP), employer-based coverage, or parental coverage) is already a strictly-enforced requirement for attendance. All students are automatically enrolled in UC Berkeley’ s Student Health Insurance Plan (SHIP). Those who chose to waive SHIP must prove that have qualifying insurance.

Many students waive SHIP because they are satisfied with their current plan. They might fear that they must change plans as a result of the new law. Although PPACA’ s goal is to stimulate the creation of new insurance options, old policies will be “ grandfathered’ into the law -- so long as the policies meet the PPACA’ s minimum coverage requirements. For students, this might mean that SHIP and other student- only plans will continue to be offered by universities across the nation.

ObamaCare Aims to Protect College Students

Policy makers finally recognized the catch-22 of students coverage: Being a full-time student means no full-time employment and thus no employer-based insurance. PPACA addresses this by allowing parental insurance coverage to apply to children up to age 26 (in effect since September 23), at the parents’ option. It prohibits insurers from excluding pre-existing conditions. In addition to increasing accessibility to students, the new law increases benefits by requiring all health insurance plans to cover preventative care measures (immunizations, vaccinations etc.) and limits premium increases. For young adults who are not interested in student-only options, PPACA offers “ Health Benefit Exchanges.” These will be established by each state to offer more affordable health plans. Exchanges will be online marketplaces that foster competition between insurers, lowering costs to consumers. The federal government also will offer subsidies to individuals to decrease the cost of insurance for those with income between 100-400% above the poverty line.

Potential Pitfalls

PPACA becomes effective along a complex timeline, delaying the implementation of new programs and regulations that could benefit students. Requirement for coverage will not be enforced until 2014. Without an incentive, students currently uninsured will probably remain so. Also, insurance policies are renewed annually, so Spring 2010 graduates whose parents’ coverage policies were renewed before September 23 probably will not have health insurance for the next year (or until the policy is renewed again).

Increasing premiums are another potential PPACA pitfall. Most student-only options are low-benefits/ low-cost plans because they are designed for very healthy young adults. As a result, not all student-only plans offered by universities currently meet the PPACA’ s “ minimum essential coverage” requirements. Increasing the benefits will increase the premiums, making health insurance financially out of reach for many students. Also, the age extension for parental coverage might decrease the enrollment in student- health plans, distributing the risks over a smaller enrollment, and so possibly further increasing premiums.

PPACA doesn’ t specifically address student-only plans, which are disfavored short-term, limited-duration plans. Without modification, students with comprehensive coverage through their universities will not qualify as having “ minimum essential coverage” and will be fined starting in 2014. Also, if the new rules regarding guaranteed renewals and general availability apply to SHP plans, then they must be offered to the entire individual market, not just to students. If SHP is rated according to the whole market instead of on a campus-only basis, it will be less affordable.

To resolve the ambiguity, many universities have requested “ ObamaCare waivers” for their student-only plans. Although many provisions do not go into effect until 2014, universities need answers now because negotiations over long-term contracts with insurers have already begun.

Ultimately the Affordable Care Act will give college students some new rights and benefits. However, until all the new rights and benefits take effect, new uncertainties will cloud the student health care market.

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About the Author: Cecilia Bonaduce studies Public Health with a concentration in infectious disease at UC Berkeley. As Chief Blog Editor of PHA Blog, she enjoys contributing articles in addition to her duties as Editor. Cecilia plans to take a year off to work in the public health field before applying to medical school. Additional interests include cooking, singing and Cal Boxing Club.

Community Gardens

EATING SUSTAINABLY

The Growth of Community Gardens and Eco-Friendly Lifestyles

By Annie Wong

In the past few years, the concept and implementation of urban farming and community gardens has sprouted across America, including Berkeley and nearby Oakland. Instead of spending money at grocery stores for organic products, more consumers are shopping at local farmer’s markets as well as picking fresh vegetables, fruits, and flowers at local community gardens. Community gardens are harvested lands that produce all types of vegetables and plants and are available for the community to pick as long as they help maintain the land. Not only do the gardens provide easy access to fresh produce, the neighborhoods that are home to the gardens also have a better sense of community, such as decrease in crime and a more conscious awareness of the environment. Community gardens are a valuable addition to residential neighborhoods, but gardens in an urban city are more difficult to establish and maintain.

Community gardens must overcome several obstacles before they can become successful and beneficial to the residents. Space is seldom found in cities, and some people believe that the land is best used for property development. A great health concern for the consumers of the garden is the constant exposure to car pollution and the possible risk of growing produce on contaminated land. In addition, many residents ask themselves whether or not the gardens will meet the needs of the community and if the gardens are efficient in providing enough food for those who need them the most. Community gardens may not be the most effective and most abundant means for providing produce for its residents, but a little can go a long way.

The gardens are not only beneficial to the consumers’ health and education, but also kind toward Mother Nature. Urban agriculture conserves energy, since there is no energy involved in the transportation of food from the farm to our table, and local production allows savings in transportation costs. The cultivation of community gardens improves air quality, promotes biodiversity, and reduces soil erosion. In addition, the fresh produce will be readily available for the consumers at much lower cost than what they pay at grocery stores. Now that fresh fruits are available for consumption, residents are more inclined to go out and buy fresh fruit instead of rummaging through their pantry for potato chips. Other advantages of urban farming include a decrease in obesity, decrease in heart disease, and a mild form of exercise for all ages. Although not all community gardens are successful, Berkeley residents have a lot support from community centers, such as the Ecology Center.

A great resource in the city of Berkeley is The Ecology Center, which, according their website, “promotes environmentally and socially responsible practices through programs that educate, demonstrate, and provide direct services.” According to the Ecology Center, the Berkeley Community Gardening Collaborative provides mutual support and common resources in order to protect existing gardens, facilitate the formation of new gardens, and advocate food safety in local schools and neighborhoods. The Collaborative sustains school gardens, nonprofit gardens, community gardens and several other types of gardens that also serve the city. Some of the other projects that the Ecology Center holds are eco-friendly workshops and events throughout the Bay Area, such as a free clinic on a lead poisoning prevention program and the Bay Area Seed Interchange Library seed swap. If you are interested in attending any of their events, you can check out their events at:http://ecologycenter.org/calendar/.

As much as I love leafy greens and juicy fruit, I am too lazy to take the bus to Safeway and too frugal to spend eight meal points on a bag of grapes. But as a student living in the dorms, fresh fruits and vegetables are readily available all over campus and in the dining commons. However, once we have our own place, not only may we be too lazy to cook, we may also be too lazy to go grocery shopping, resulting in constant trips to Chipotle and endless consumption of Cup Noodles. Luckily, the Food Collective is conveniently located across the street from Eshleman Hall. The store carries everything from vegetables and fruit to organic lotion and eco-friendly laundry detergent. The employees are very knowledgeable about their products and are open to answering any questions you have about their products.

Another great way to satisfy your craving for fresh produce is to go to the Berkeley Farmers’ Market on Tuesdays, Thursdays, and Saturdays. The Farmer’s Market is open all year round, rain or shine, and they are all only a short bus ride or walk away from campus. The Saturday Farmers’ Market is located on Center Street at Martin Luther King Jr.Way from 10 a.m. to 3 p.m. The Tuesday Farmer’s Market is located on Derby Street at Martin Luther King Jr. Way from 2 p.m. to 7 p.m., and 2 p.m. to 6 p.m. in the winter. The Thursday Farmer’s Market sells only organic products and is located on Shattuck Avenue at Rose Street from 3 p.m. to 7 p.m.. Other great products that are available at the Farmers’ Markets are fresh baked goods, jams and preserves, fresh squeezed juice, olive oil, goat milk and cheeses, prepared foods, and flowers and plants.

As a Berkeley resident, there are numerous resources that support a friendlier and healthier lifestyle. Whether an individual takes on the responsibility of a community garden or purchases organic produce or goods, the individual will be making a positive impact on our environment. Residents Berkeley community can make small changes to their lifestyle, creating a difference in their health as well as the environment.

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About the Author: Annie Wong is a first year intended Public Health major. In her free time, she likes leisurely reading, playing board games, watching movies, and wandering around the Berkeley campus.

GOING GLUTEN FREE

The What, Why and Where of gluten intolerance and Celiac disease in the Berkeley Community

By Cecilia Bonaduce

More and more people are being diagnosed with gluten sensitivity or Celiac Disease and, as a result, gluten-free foods and menus are popping up all around the country. Although only recently catching the eye of the media, Celiac Disease has long been affecting the human population. For years the medical community failed to realize the prevalence of Celiac Disease. According to the National Institute of Health, up until ten years ago, medical schools taught that only 1 in 2,500 people have Celiac disease. Today, we know that 1 in 133 people have Celiac Disease but only 1 in 4,700 is ever diagnosed. What is Celiac Disease? Why is it so egregiously under diagnosed? How do you live on a gluten-free diet? The answers to these questions could be critical to bettering your health.

Before Diagnosis:

Many people suffer for years with symptoms such as abdominal pain, chronic diarrhea arthritis and anemia before achieving a proper diagnosis. Correctly diagnosing Celiac disease is very difficult because the symptoms of Celiac disease mimic the symptoms of many other chronic conditions such as IBS, GERD and macrocystic anemia. After ineffective treatments and invasive, yet ineffective, diagnostic tests, patients lose their good will and become frustrated with both their doctors and their bodies. The correct diagnosis represents a small victory in a long line of obstacles that the patient must face. Adopting a gluten free lifestyle is the real challenge.

The Diagnosis:

Celiac Disease is an autoimmune disease that damages the small intestine in response to the consumption of gluten. The damage to the small intestine prevents the body from effectively absorbing nutrients resulting in severe malnutrition and various other symptoms. There are four major steps involved with diagnosing Celiac disease: a physical examination, blood work, a biopsy of the duodenal and the implementation of the gluten free diet. If the gluten free diet causes the symptoms to subside and the patient’s small intestine to heal then the diagnosis of Celiac disease is confirmed.

After Diagnosis:

If the patient strictly adheres to a gluten free diet then their health and quality of life should increase greatly. The time it takes to experience relief from symptoms varies from person to person and depends on the ability of the person to avoid all gluten and age (it takes longer for adults to heal). Although the small intestines take anywhere from months to years to heal, relief from symptoms such as cramping and digestive problems should subside fairly quickly. A quick recovery from Celiac symptoms is often hard to come by because new patients have yet to master the gluten free diet which can be quite tricky to adhere to. Over time the person with Celiacs will heal and the gluten free lifestyle will become second nature.

Recovery:

Although no cure for Celiac disease currently exists, there are ways to relieve the potentially debilitating symptoms of Celiac disease. There are three rules every gluten free dieter should live by to have a healthy life:

1. Memorize – People with gluten intolerance must memorize safe and unsafe ingredients. For example, the Celiac must know that; malt flavoring, wheat starch, spelt, soy sauce, and couscous are unsafe ingredients. They must also learn how common restaurant foods are prepared. For example, someone with Celiac Disease must know not to order tomato bisque soup at a restaurant because it is often thickened with wheat flour. Lastly, they must know the manufacturing process for many foods. For example, oats are technically gluten free; however, the manufacturing process results in gluten contamination and, thus, must be avoided.

2. Commit – If you have Celiac Disease or gluten sensitivity you must commit whole-heartedly to a gluten-free lifestyle. Even a “little bit” of gluten can cause a lot of damage. When someone has just baked a fresh cake and says “just one bite won’t hurt” the Celiac must not give in. A 100% gluten-free diet is the only way to sustain a healthful lifestyle. Even the slightest bit of gluten can damage the body’s ability to absorb nutrients.

3. Question – A gluten-free lifestyle requires that you interrogate chefs. Whether at a friend’s dinner party, or at a restaurant, if you cannot eat gluten you must be ready to ask about how the food is prepared. Is the soup thickened with flour? Is the meat braised or dusted with flour? Are the French fries fried in the same oil as breaded foods like chicken strips? Does the restaurant make its chicken or vegetable stock fresh daily? Finding out about how the food is prepared is the only way to avoid gluten contamination while dining out

Going gluten free, though challenging, can drastically improve your health. If you think you might have Celiac Disease talk to your physician right away. For more information, go to www.celiac.org.

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About the Author: Cecilia Bonaduce studies Public Health with a concentration in infectious disease at UC Berkeley. As Chief Blog Editor of PHA Blog, she enjoys contributing articles in addition to her duties as Editor. Cecilia plans to take a year off to work in the public health field before applying to medical school. Additional interests include cooking, singing and Cal Boxing Club.