What it Means to be in College Without Access to Healthcare
During the 86th Texas Legislative Session, auto enrollment was a regular topic surrounding the discussion of improving women’s healthcare. Several bills proposed common-sense solutions to improve continuity of care for women utilizing publicly funded healthcare programs – like Children’s Medicaid – through auto-enrollment into Healthy Texas Women (HTW) when they were no longer eligible for their current program. House Bill 1879, proposed to auto enroll young women aging out of the Children’s Health Insurance Program (CHIP) and Children’s Medicaid in to HTW.
HTW provides a limited array of services to eligible women including, pelvic exams, contraceptive services, and screenings for chronic conditions like diabetes, high blood pressure, and cholesterol. It often serves as a healthcare entry point for low-income and under insured women.
This particular demographic, young adults aging out of full-coverage publicly-funded health insurance programs, can find themselves in a tough spot. Graduating high school, entering college, and no longer having health insurance coverage can lead to difficulties if something happens. Many of the conversations surrounding the transition from high school student to college student focus on safety, responsibilities, and campus life. But you’d be hard pressed to hear much about navigating the state-funded healthcare programs available to low-income or underinsured students.
As spring 2019 embraced Austin and the Texas Legislature began its final sprint toward Sine Die, high school students around the country began preparing for graduation and their next step – college.
Brownsville native, Marla Lopez, remembers the anticipation of high school graduation well, even if it feels like lifetime ago now. After four years at the University of Texas at Austin, she was close to completing her studies and receiving a Bachelor of Arts in History. It was hard not to spend some of that time thinking about how far she’d come since that first day on campus for orientation four years before.
“I got my wisdom teeth pulled two days before orientation and I was walking around the UT Austin Campus in the heat,” Lopez said. “It was terrible, but I was very aware that my time with healthcare was going to come up.” The decision to have her wisdom teeth removed was because she knew her time with full coverage insurance was coming to an end.
At the end of the month of their 19th year, a CHIP or Children’s Medicaid recipient, like Lopez was, ages out of the program. When students who have worked hard to get into college arrive, they can come up against the hard truth of a fractured healthcare system. There aren’t many places to turn when things like mental health, chronic health conditions, or women’s health issues present themselves.
Lopez is intimately familiar with the anxiety that can settle in on a first-generation college student, and she knows how the stress of lacking insurance can compound that anxiety.
We talked about how Children’s Medicaid impacted her life, how navigating college while searching for healthcare access was a challenge she wasn’t quite prepared for, and how auto enrollment into Healthy Texas Women might have made things a little bit easier.
What was your first interaction with Children’s Medicaid and how did it assist you and your family?
I was enrolled in Children’s Medicaid probably around the age of 10. That same year, I ended up in the emergency room because I had a terrible asthma attack. It was during the summer, it was hot, and my allergies were awful. Then I just couldn’t breathe. I got out of the car and I was barely capable of telling my brother to get my mom. He was maybe seven at the time. My lungs swelled up and closed and I passed out.
They took me to Valley Regional Emergency room. My mom’s very capable of navigating hospitals because she speaks English, and the area is majority Hispanic, so even if she hadn’t spoken English, somebody would have been able to help her. In that aspect it wasn’t hard to navigate the hospital and healthcare. I’ve been fortunate, because I have so many neighbors who don’t know how to work within those systems.
After that, I started going through allergy treatments and saw an allergy specialist. There was no cost.
When you were in high school, how cognizant were you about your time running out on Children’s Medicaid?
I wasn’t really aware until my last year of high school. But while I was a sophomore, I’d been moving furniture around at home, and then laid down and went to sleep. I woke up around four in the morning with insane cramps, I thought it was my appendix. We went to the hospital and they found an ovarian cyst had burst.
I also wear glasses. I wanted to get some nice ones before the insurance ran out, so right after I graduated high school I worked at a water park to pay the difference. I had no idea how expensive frames were!
When your time on Children’s Medicaid ended, were you thinking about insurance options available to you?
During my sophomore year of college, I went onto the Affordable Healthcare Marketplace and checked it out. Even though it gave me a good breakdown of the deductible and what I was eligible for, I didn’t really understand any of it.
I messed around on that site for awhile and realized I didn’t make enough money for anything there. I had federal student loans and was on federal student aid. The only reason I was able to come to Austin was because I got a four-year scholarship. It would have been almost impossible. Had I purchased ACA insurance, I would have been living off ramen.
When did you realize the state might be able to help you?
Trying to get insurance through the ACA was how I figured out I could look to the state to see what they offered. My mom told me, “Why don’t you look into getting food stamps. You’re a student, they gave you a scholarship, and you aren’t working full time. All they can tell you is no.”
I applied and was rejected for food stamps, but on the bottom of the rejection letter they wrote that I could apply for the Healthy Texas Women program.
How did the application process for HTW go?
I went through the website for at least an hour. On the site, it gives you info about who is eligible for the program and what services they offer, but it wasn’t completely clear.
The application process was long. You must have your bills, paystubs, and other types of info to enter into the system. It took me three days over separate sessions to complete everything.
I also didn’t understand that you have to renew as often as you do. When it was time to reapply I was like, “I have to do all that again?!”
What advice would you give to young women looking for insurance?
One, find other women who have gone through it, and two, the internet is everything. The only way I got through it was by reading everything I could. Not everyone has the privilege of time or the resources when it comes to doing it all.
It’s easy to feel trapped, but you’ve got to keep pushing. I didn’t know about TWHC until Erika [Ramirez, TWHC Policy and Advocacy Director] told me during Movement Mujeres group. There’re people out there.
As young people, we get caught up in our own little bubble. You just have to go for it.
What do you wish legislators knew about the process of finding and securing insurance?
A lot of our legislators are men and they don’t have to worry about all these annual exams women have to go through. At UT this past year almost, 20 percent of students were first-generation college students. We do understand struggle that comes along with being a minority in this country, but we don’t have the knowledge or the generational wealth that comes with just being able to call somebody to solve a problem. Many of us are the first ones in our families to do this.
I was just thinking the other day, “What am I going to tell young people when I get older? That I put myself through college?” No. I had to break my credit, before I had credit, to put myself through college. Legislators must understand there are so many things that may not have affected them, that now affects us. They may say they listen to their constituents, but you don’t know until you’ve been through it.
HTW is not full coverage insurance, and while it would not have assisted Lopez with other health challenges, like dental or asthma, it would have provided her with at least some access to healthcare as she continued her college studies.
None of the auto enrollment bills filed during the 86th Texas Legislative Session became law. One bill that would have required universities and community colleges to send information to students about publicly-funded healthcare programs, like HTW, also failed to get the necessary support.
Perhaps these bills will be refiled during the next Legislative Session. Until then, young people from low-income and under-insured families will continue to walk the tree-lined sidewalks of Texas university and community college campuses. They will question their professors, search for answers on the internet, and ask their librarians for guidance. But will they know who to turn to when a health issue arises, and they need access to basic healthcare services?
This interview has been edited and condensed for clarity.
Originally published for the Texas Women's Healthcare Coalition.