Cardinal Care backlash

March 4, 2010, 1:06 a.m.

The University’s move last month to require international students to purchase Stanford-provided Cardinal Care for the 2010-2011 school year has become a lightning rod within the international student community, prompting a student-led petition to kill the new requirement, concerns among foreign students of University discrimination and administrative talks on whether to loosen requirements of the plan.

Under the revised policy, international students will be obligated to purchase Cardinal Care — the University’s $3,000 annual healthcare package — in 12-month increments. Currently, Stanford’s insurance policy has an “opt out” mechanism that allows students to forego Cardinal Care if they provide proof that they have adequate insurance coverage from another source, such as parents, a spouse or another insurance provider.

Domestic students remain free to choose their own insurance provider.

Currently, seven percent of the undergraduate population, or 488 students, are international. Thirty-two percent of graduate students, 2,734 students in total, are international.

Requiring Cardinal Care solely for international students “is discriminatory because it assumes that domestic students can better evaluate whether their coverage is adequate or not,” said Fabian Sahl, a graduate student in International Policy Studies. Sahl has been at the forefront of the opposition to the mandatory coverage plan, co-authoring a petition that demands that Stanford revoke the proposed plan and keep the existing policy. The petition had more than 500 signatures on Wednesday night.

Ira Friedman, director of Vaden Health Center and a major proponent of the Cardinal Care plan, has seen first-hand what happens when international students fall through the coverage cracks.

“I see these folks drowning in the river,” Friedman said, “and I think, ‘Can’t we put a fence upstream to keep them from falling in?’”

Friedman said the issue of compulsory Cardinal Care for internationals was recommended as far back as 2008 in the Student Mental Health and Well-being Task Force Report. He backs the proposal because he said it provides a safety net that will eliminate medical snafus that have flared up several times a quarter — “problems that occur almost exclusively for international students.”

Friedman said that about 80 percent of international students already buy Cardinal Care, but the 20 percent who have other coverage plans have run into problems ranging from being denied in-patient treatment for mental health conditions to having to relocate to a county hospital when they have a medical emergency.

But for Sahl, Friedman’s well-meant fence curtails his personal choice.

“This is a private institution, and the move is paternalistic,” Sahl said. “We can very well decide for ourselves if our coverage meets the standard that Cardinal Care does.”

Sunil Sandhu, a Ph.D. student in electrical engineering and native of Singapore, rejects the move on principle, calling it “collective punishment rather than corrective action.” He is currently covered under Cardinal Care, but is considering opting out.

“I think everyone should have their own choices, “ Sandhu said, citing his own personal care packages, which he said are tailored to back injuries he sustained in a recent fall. Cardinal Care doesn’t cover Sandhu’s specific physical therapy expenses, and his inability to tailor-make his care package is a problem.

“How much mental coverage do you really need?” Sandhu asked. “Vaden says you need X amount for mental health and X amount for injuries. How can they decide that? It varies from person to person. It makes no sense.”

In mid-February, after the proposed changes were announced, concerned members of the international community wanted answers. Adeline Agut, a graduate student in civil and environmental engineering and member of the French Student Association, along with John Pearson, director of Bechtel International Center, organized meetings with Friedman to discuss steps to get the administration to reconsider the plan.

As an alternative, students asked the University to lay out guidelines for what is considered minimum acceptable coverage and require students who wish to waive Cardinal Care to provide written statements of benefits from their alternate provider.

“From what I’ve heard, Stanford is pretty open to negotiations,” Agut said. “When they say they want the best for us, I believe them. I don’t think they’re evil.”

In meetings with Friedman, students also asked that the University extend the time frame for reviews of the new plan in order to get more student input.

But Sandhu questioned why students — specifically graduates — were blindsided by the policy shift in the first place and left having to scramble for a last-minute response. He blamed a lack of internal communication between the GSC and the Vaden Insurance Advisory Committee (VIAC).

“The GSC just let these guys [the VIAC] go, and there was no coordination,” Sandhi said. “So if, from the start, the VIAC heard that there was this move to get mandatory Cardinal Care for international students, they should have communicated with the GSC and said that this is going to happen. If they had, we wouldn’t have been in this mess.”

Daniel Becker, an electrical engineering Ph.D. student from Germany, is currently on an insurance plan offered by a private German company targeted specifically toward extended stays abroad. Becker’s insurance plan — which costs around $110 per month — provides worldwide coverage, includes dental, vision and prescription drugs, and allows him to freely choose which doctors to visit without the need for a referral, he said. Cardinal Care does not include dental or vision coverage and provides limited out-of-network coverage.

Becker is concerned with the higher premiums he will have to pay under Cardinal Care.

“My biggest concern with mandatory enrollment in Cardinal Care is the loss of coverage compared to my current plan,” Becker said. “Most importantly, Cardinal Care only reimburses 80 percent of the cost incurred at out-of-network providers. Given that serious injuries or illnesses can easily lead to immense health care bills, this puts me at a significant financial risk any time I travel, be it for attending a conference or for visiting my family back home.”

Sahl is currently insured under a German plan that cooperates with the Swiss provider Elvia in the United States. He said that the cost of his insurance policy is roughly $2,000 dollars cheaper a year than Cardinal Care.

Friedman acknowledged that some students, such as Becker and Sahl, are savvy healthcare purchasers and have chosen cost-effective alternatives. For students like those, Friedman is negotiating a “feasible process for exceptions.”

“We’re listening very carefully to student feedback on this,” Friedman said. “The policy is aimed at trying to address a problem that is occurring only exclusively in one quarter of the student population. From a public health viewpoint, we can and should try to address it.”

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