How changing our healthcare system impacts science: my experience as a postdoc looking for insurance

In 2005, I heard that I had received a National Science Foundation (NSF) postdoc to go work at the University of Wisconsin. I was thrilled about the opportunity, and really looked forward to starting. But, as I worked on the logistics of moving, I discovered a major hurdle: because the National Science Foundation would pay my stipend directly to me, the University of Wisconsin didn’t consider me an employee, even though NSF was also sending them an institutional allowance in exchange for hosting me. The biggest impact of this was that I was not eligible for health insurance through the University of Wisconsin. Instead, I had to try to purchase health insurance as an individual. At first, I was denied coverage.

Based on conversations I’ve had over the years and replies to some tweets I wrote, there are a lot of people who have found themselves in similar situations. In this post, I’ll talk about my experience more and talk about some of the ways this might impact science.

When I first learned I would need to apply for insurance on my own, I didn’t think it would necessarily be a big deal. I thought of myself as being pretty healthy. Sure, I had allergies and asthma, but they were well controlled. So, I applied for insurance and didn’t really worry about it. Then I heard I was denied coverage because I had pre-existing conditions (allergies and asthma).

Prior to the Affordable Care Act (popularly known as Obamacare), insurance underwriters would evaluate applicants to determine how risky they seemed and how much coverage to offer. It meant that some people were unable to find coverage at all, while others had to settle for policies that cost more and covered less.

I ended up being relatively fortunate. Based on the way the Michigan State student health insurance worked, it automatically covered me for the first several months of my postdoc. (I think it covered me through August – that is, my first 6 months – but it’s possible my memory is off on the exact details.) I was then able to extend my student insurance (through COBRA) for longer – again, I can’t remember the exact dates, but I think it was 6-12 months. That bought me time, and, during that time, I was able to shop around and find a plan that would cover me partially. It didn’t cover anything related to allergies and asthma, and it didn’t include maternity coverage, but it did cover everything else.

Wisconsin is far from alone in saying people with NSF postdocs are not employees. This happens at many (but not all) universities and is a major sticking point. I know people who have turned down these postdocs – even though they are really prestigious and otherwise a pretty amazing support package – because they would be unable to get health care on the private market. Think about how this impacts access to prestigious research opportunities: women and people with disabilities are disproportionately impacted when they need to purchase health insurance on the private market.

Since I had time to plan, I started a process where I would fill my prescriptions religiously every month but then only take the medicine two days out of three (or every other day if I could get away with it) so that I would still have the medicines I needed when I was off my student health insurance. This lack of access to medicines (which made it so that I was a much more effective scientist!) was a major problem under the old healthcare system. Sarah Hörst had a tweetstorm about how students in her grad program dealt with not having prescription drug coverage before the Affordable Care Act. The short version is that her father helped grad students get samples from drug reps. That was the only way they could access the medicines they needed.

And, even though I was initially denied healthcare and then ended up on a plan that was not comprehensive, I still consider myself lucky. I was only able to extend my student health insurance because the MSU grad students had recently unionized. Before that, the only health care available to students was in (or very near) East Lansing, which would not have been useful to me in Madison, Wisconsin. I was able to use COBRA to extend my student insurance, which isn’t true everywhere. I had time to plan for a gap in prescription coverage. While I was on the individual plan, I never had an emergency: a trip to the ER for any problem that could have been related to asthma or allergies would not have been covered. I didn’t get pregnant.

I was also lucky in another way: as a postdoc, I didn’t yet have a diagnosis for anxiety and hadn’t yet had a cesarean section. But with a slightly different life path, those would have been in my medical record when I was applying. And, if they had been, it’s likely that I wouldn’t have been able to find a health insurance plan at all.

This impacts science. If people are not receiving the healthcare they need (because they lack insurance or fear that receiving care will impact their ability to get insurance in the future), they will not be as effective as scientists. And if they need to purchase health insurance as an individual, it cuts off opportunities to some people, and those people are disproportionately women and people with disabilities. I know people who are likely to move to postdocs in the next year or two who are very worried about whether they would be able to find health insurance if this new law passes.

And, while the inability to purchase comprehensive, affordable health insurance while on certain fellowships is a problem, it is far from the only way scientists – and, therefore, science – will be impacted. To list just a few: People who work as adjuncts or short-term technicians will once again find it much harder to access health care. As Susan Perkins noted on twitter, people who are being harassed or bullied at work will feel unable to move. And even employer provided health care policies might be impacted.

So far, the bill has just passed the House of Representatives. That means there is still time for the bill to change. But, as it stands, this bill will impact science and restrict who gets to do science. I hope that won’t come to pass.