For some Notre Dame community members, a minor infection or fever can be a major source of anxiety.
Angela Campbell, a Canadian citizen whose husband is a graduate student in political science, has lived without health insurance since the couple arrived at Notre Dame five years ago.
Campbell was recently sick for six weeks, and put off medical care for as long as possible.
"I just kept saying, ‘I just have to get better, I don't want to go to the doctor,'" she said. "In the event that something really bad would happen, I would probably just get in my car and drive [nine hours] to Canada."
Notre Dame's health insurance premium for spouses of students is over $4,000, and Campbell doesn't qualify for state healthcare.
The cost for insuring a spouse and all children this year under the University's health plan is nearly $7,500 for each family. And with graduate students making as little as $17,500 per year, Campbell said purchasing University health insurance is almost impossible.
The Campbells' situation is not unique for graduate student families, both international and American. With the University's high premiums for dependents, and difficulty finding alternate coverage, many graduate student families must resort to paying out of pocket for routine medical care.
Greg Sterling, Dean of the Graduate School, said the University has been working for a long time to find a better solution for these families.
"This is an issue that keeps me up at night; I feel terrible about it. And there's nobody who doesn't want to help in the central administration — the challenge is the cost," Sterling said. "Right now, sometimes people say, well, ‘the University has money.' Well, the University does have money, but it's all committed. And so you make choices."
But the costs, he said, are staggering—up to several million dollars each year.
"It would take several million dollars per year. It's not one time. If we could come up [with] $2 million to fix the problem — it's not just for one year; it is every year," he said.
Since becoming Dean in 2008, Sterling has been addressing two main priorities for graduate students — their stipends, which have gone up, and their health insurance. Health insurance for the individual student has become more affordable.
Healthcare affordability for the families of graduate students, however, has been an issue since University Health Director Ann Kleva came to Notre Dame in 1994.
"It's just been a very sensitive issue for all the years that I've been here, the cost of family health," she said. "Health insurance for any family today is very, very expensive…especially when you're on a limited income."
At The Village: Ways of Coping
Campbell said healthcare issues are almost a fact of life within the University Village community, Notre Dame's student family housing.
"Everyone, every one of my neighbors has major issues with health insurance or they're uninsured," Campbell said.
What she said really scares her is the prospect of needing emergency or long-term medical care.
"I always hope that if something really bad happens it's in our car, because our car insurance covers the medical cost," she said. "[I think] ‘if I have to break a leg, please let it be in my vehicle.'"
Campbell's husband is insured by the University plan, and the Campbells' two sons are American citizens, so they qualify for Hoosier Healthwise— Indiana's state Medicaid plan.
But the Campbells' first daughter, 6, is a Canadian citizen and only qualifies for emergency healthcare under the state plan.
"It's very stressful," Campbell said.
Nathan Elliot, rector of University Village, said international children are the most vulnerable under the current healthcare setup since they only qualify for emergency care under the state plan.
"Here at the Village we have a pretty good network of people who share what they do with others, that's fortunate," Elliot said. "[But] at least the way I think about it is it shouldn't have to be that complicated, I think we could do better."
Why are the premiums so high?
Sam Rund, president of the Graduate Student Union (GSU,) said every time someone asks him what issues are most important to graduate students, insurance for dependents is at the top of his list.
"It could literally be a life or death issue for someone," Rund said. "There's this extra special obligation I feel to fight for insurance coverage for these people."
The question many graduate students have is: why can't Notre Dame, a well-endowed University, make healthcare for families more affordable?
Some graduate schools of comparable universities offer much lower premium rates for families. But Sterling said comparing Notre Dame to other schools wouldn't be comparing "apples to apples," because universities with lower premiums may not have as comprehensive a plan as Notre Dame.
"A lot of the differences you see in the price will depend on the level of services the insurance provides," he said.
He said that Yale University, which provides a very reasonable health plan for families, also has a much greater endowment per student than Notre Dame does.
Ricky Klee, a graduate student in theology, said by making it difficult for graduate students to have families at Notre Dame, the University is going against its Catholic background that promotes family life. Klee has participated in protests outside the Main Building the past few years and helped coordinate a petition to the administration in the spring of 2010.
"Doing the numbers it is expensive, it's almost a million dollars a year," Klee said. "But [comparing that] to varsity athletics teams, increases in executives' salaries…the question is, which is imperative. It's more important to make sure the kids can go to the doctor."
Sterling said a significant amount of the University budget has gone to the Graduate School in recent years, and much of that money has contributed to the rise in student stipends—something that is beneficial for every student.
Even within the Catholic faith, Sterling said, some students say it's the University's responsibility to provide healthcare for families, while others think it's a personal responsibility.
"Another factor which people will ask and debate is the role…the extent to which the University is responsible, versus which the student is responsible for their own family," he said.
Future Effects of Healthcare Reform
Sterling said he recognizes graduate student families have an immediate need for healthcare coverage. But there's no "magic wand."
"I do think that we would like to find a far better solution to this than what currently exists because what currently exists is not good," he said.
Sterling said with the stipulations of healthcare reform, which will be phased in next year and eventually require the University to provide unlimited coverage, premium prices will continue to rise.
He said the Graduate School has been looking at different ways to cut the cost of healthcare for dependents. One solution would be to provide discounted clinical service at the new Wellness Centerthat will open in July.
"We've lobbied, and with a great deal of sympathy from the Provost, and the Executive Vice President, and the President, to have the spouses and dependents of graduate students receive healthcare from the Wellness Center," Sterling said.
But right now, there are no specifics.
Kleva said she anticipates the situation to remain difficult for graduate student families until healthcare reform passes in Washington, D.C.
"Personally, I believe [healthcare reform] truly will be a benefit for lower income families that need healthcare insurance, because they'll have options and the government will be offering subsidies for those that meet income levels," Kleva said. "Again, you don't know when all this is going to pass."
With University premiums projected to rise over the next few years, government subsidies that come with healthcare reform may be the only promising option for many graduate student families at Notre Dame.
"I have to say, I love ND for so many reasons, it is really a wonderful place to be," [Angela] Campbell said. "[But] being in the Village we're quite forgotten and health insurance is just another thing on the list."
