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Caltech for Affordable Healthcare

During the COVID-19 pandemic, California Institute of Technology administrators announced that graduate student health benefits would be cut starting in September 2020. Caltech for Affordable Healthcare (CAH) formed to oppose these cuts and advocate for access to healthcare.

CAH’s Petition

Caltech for Affordable Healthcare formed after concerned students learned of cuts to our health insurance benefits which were proposed by Human Resources to the Faculty Standing Health Committee in March and April 2020. We drafted a petition based on feedback from 260 graduate students on the demands and contents. This petition was was signed by 553 graduate students (42.6% of the grad student population) and endorsed by 24 student groups.

Press Release

On May 8th, 2020, just after administrators announced the finalized healthcare cuts, CAH put out a press release.

Grad Student Stories

CAH continues to solicit stories from graduate students about their experiences using the student health insurance plan.

Student #1

When I first arrived at Caltech, the medication I had already been taking to manage my chronic health condition required pre-authorization by the insurance company and was around $10 000 a month, so I really could not pay for it and try to recoup the money from the emergency fund later. My doctor’s request for pre-authorization was denied and I had to appeal it twice. In the few months it took to process the appeals, I was not taking the medication and my previously well-managed symptoms returned. When the insurance finally went through I learned that I had developed anti-bodies to the medication. I strongly suspect this was related to the period of time when I was off the meds. This began a lengthy process in order to find a new medication that works for me.

Student #4

Stopped going to a very helpful physical therapy due to the price (~250$ deductible, ~30$ per visit afterwards. In comparison, my experience in a Canadian university was 0$ deductible, 10$ per visit.)

Student #6

Just last October, I had to pay more than $1000 in health costs and fees after ONE diagnostic procedure. I still have to schedule an actual surgery based on the diagnosis, which is probably going to double this cost at least. This significant of a cut on medical benefits in addition to raising premiums puts an even bigger strain on my finances than it already has, and I don’t think a small raise in our stipend would cover that difference, as well as adjusting for inflation. As for mental health benefits, I attend therapy once a week, and I cannot afford a cut on those benefits either.

Student #8

On the whole, I haven’t had many issues with healthcare personally. My one poor experience with Caltech healthcare was when I was doing PT at an office that was in network but then got switched to out-of-network but I was not notified of the change. Luckily I only had a few more sessions left so my bill was manageable, but I know other people who went for weeks more and were left with massive bills.

Also I’ll have to check on this but I think in terms of sexual health they offer fewer services than other institutions. Practically every woman I know at Caltech goes off campus for gynecological appts/services.

Student #10

As a student-parent, I’m concerned about rising costs for my dependents. We tried getting my son insured through Medi-Cal, which didn’t work out. Our application took longer than it should have to get insured, so we canceled the application and put him on Caltech insurance. We got billed for Medi-Cal kicking in eight months later, a total of ten months after we moved to SoCal and initiated our application process. As such, a cheaper alternative was not an option for taking care of my child. My husband was insured through the California marketplace, but do to a billing error, his insurance was canceled and we were not notified. As such, he was uninsured without our knowledge for three months. So, we also put him on the Caltech plan. Now that we have access to healthcare, our only option is Caltech insurance. We tried cheaper alternatives, and they left us without insurance. I appreciate the reimbursement that covers some of the premiums for dependents, but rising co-pays are not good for people (with dependents or not) who need to frequent medical visits, which certainly is the case for people with small children who are supposed to have wellness check-ups frequently early on. Furthermore, if people need to travel for medical visits (e.g. we need to see a specialist at UCLA because more local doctors are out-of-network, another issue with accessibility), the effective co-pay goes up because parking is $12 with no validation offered.

Student #12

I’m worried about the potential increases to costs. I am afraid I might not be able to afford it, as a student under academic scholarship. If not for the scholarship, I wouldn’t have been able to study here in the first place, so it is a burden to bear in addition to all the other costs I am currently covering with my scholarship (rent, food etc.).

Student #14

I was diagnosed with autism recently, and was recommended to start occupational therapy to help deal with my sensory overload while working at Caltech. The waiting list for such an occupational therapist is very long and I will not be able to get into their office until next year. I anticipate meeting with them 2x/month next year, on top of weekly visits to a therapist to help work through all of the other aspects that come with figuring out why I am different and dealing with it. In the new health plan, the cost of the weekly therapist will increase by $380, and occupational therapy will add an additional $600 to my yearly expenses, an additional $240 under the new plan. I have met the deductible for other reasons every year, so I probably will this year as well, adding $250. In total, I expect the changes to add $870 to my medical expenses, without accounting for the increase in premium. This will make me take a hard look at whether to follow through with occupational therapy, which is a shame, because I’ve been working here all this time with a handicap and now I may not be able to figure out what I can do with proper treatment.

Student #16

I am relatively healthy so I have largely avoided many health care visits. However, I want to note that I believe raising health care costs is a serious mistake. As a whole, I am largely hesitant to use health care services because I have no idea what “hidden costs” may be incurred and I’ve heard way too many horror stories about the American health care system. I wholeheartedly support the effort to mitigate health care costs as much as possible since those who are required to depend on repeat treatments should not have to shoulder the burden alone. Despite what Doug Ree’s email said about health care at Caltech being “comparable” to other top STEM institutions, I simply believe that is “settling for the status quo” which is not nearly good enough.

Student #18

Besides all the terrible cuts to coverage, I want to add that there are important services that are not all covered – neither on campus nor outside – like physical therapy. I spend my whole day sitting in front of a computer and I have shoulder and wrist pain. I went to the health center and they said I needed physical therapy but they admitted that they didn’t want to refer me because it was too expensive (it is 20% if in network after deductible, and the usual cost per session is around $400)… And here I am, I had to buy (of course with my own money) lots of orthopedic stuff to try to alleviate the pain while working. And this is a work-related injury! Caltech’s health center could at the very least have a physical therapist. They have one in the gym, but you can only go if you’re an athlete and only for athlete-related issues.

Student #21

I have not been personally affected, but I’ve seen many of my fellow graduate students who have relied on their healthcare, especially for mental health. Raising these costs makes it even more difficult for them to receive the necessary care that enables them to succeed in their graduate work.

Student #22

Having $500 of deductible will make essentially every procedure that is non-preventive unaffordable for the majority of grad students. I am a perfectly healthy person that never thought would care about this, but last year on a routine visit I had a mole removed and I instantly hit the deductible! If it was $500 I would certainly not be able to pay for it, and most likely chose not to do it.

Student #24

I go to psychological therapy twice a week (sometimes 3), and I’m under psychiatric medication, so I also visit a psychiatric office every so often. I kill the first 25 visits almost always by November, and pay around $200 mostly on mental health already (including the medication). If copay raises $10, it will mean more than $100 extra every month on mental health. This will essentially make me cut on mental health visits, which makes me genuinely worried because they are very much needed.

Student #26

I had a really difficult time adjusting to Caltech. So much so that I tried to kill myself last year. I was taken to 2 hospitals and the cost of both stays and the ambulance ride was over $16,000. I was lucky that I was on my family’s plan still because my mom is just about to retire. If I had just been on caltech’s insurance I would have been in debt with the maximum payment. It costs a lot to move to California and I didn’t have much savings. If I was to fall into a similar situation I may have had to consider leaving grad school for a better paying job.

Student #27

I was not able to get the amount of physical therapy sessions requested by my physical therapist (PT) because the Caltech insurance only covered 12 visits per injury for PT. Knowing there was 12-visit limit, my PT requested only 3 additional covered visits to the insurer beyond 12, and they were not granted. So I was left mid-treatment without proper care, and with only a few exercises to do at home to heal my neck and back injury (which affected my ability to work for a full day).

The cost of the 12 sessions with insurance added out to almost $500 overall out-of-pocket, and any more sessions beyond that would have been more than $300 per each non-covered visit, which is cost prohibitive for me.

Student #30

1) During an ER visit while at Caltech, I had to pay $2000 out of pocket for needed tests that Caltech health care wouldn’t cover. 3) I have had to skip weeks of very important mental health therapy because Caltech limits the number of sessions we can have in a year. This has adversely effected my work as well as my mental health

Student #31

Haven’t had access to mental health care which has impacted me significantly.

Student #32

I avoid taking care of my medical needs due to cost. I have EoE which requires a GI specialist, pulmonologist, and allergist. It also requires medication and regular procedures like endoscopies. Last year I decided to try and do a better job managing this in addition to my asthma (which requires > $70 per month in prescription costs). I ended up with hundreds of dollars in co-pays in addition to the hundreds of dollars worth of hidden costs of endoscopies. I would like to be able to take care of my health without paying this much.

Student #34

As a healthy individual, I luckily don’t use the health insurance as much. However, with the new pandemic I am very concerned. My brother and other family members recently became infected with COVID. Without any pre-existing condition, they stayed in the hospital for up to three weeks, and some of them even required intensive care. This happened to healthy individuals and it could happen to any of us. How does Caltech dare, in the middle of a pandemic, to cut healthcare coverage to students? What if I get COVID and I need to go to the hospital? Will I need to pay $500 of deductible just by entering the hospital, and $2000 of out-of-pocket if I need to get hospitalized?! This is not affordable and it adds up to the stress that we already have in the middle of this situation. If those changes go in effect, I will move to my home country until the end of the pandemic, to ensure that I will be able to access healthcare needed to treat COVID without going bankrupt. Besides, raising copays (hence cutting on mental health affordability) on these times does not seem a wise decision. Anxious students do not work well!

Student #36

I have been impacted and will be impacted further by unaffordable healthcare. Currently, I visit a mental health counselor once (sometimes twice) a week for managing family issues and not letting it affect my work. I am happy with the current plan of having the first 25 sessions free and having a $15 copay after that. Under the new proposal, I will end up paying a lot more for this essential service. Last year, I also spent about $2500 after insurance to get a root canal. It was not a procedure I could postpone because I had already postponed it as a college student when I couldn’t afford the service. It is very important for us to have adequate health insurance, including affordable off-campus mental health care and dental care.

Student #38

My partner (a Caltech student) had mental health issues and finally decided to go to the counseling center last year. They recommended he saw an off-campus provider, and told him that 25 sessions were a lot. After his 25 sessions, he still was not doing well (as happens to most people with severe depression), but he was hesitant to continue in therapy because of the copay. He had been recommended medication for a long time but he had been avoiding it because it apparently requires multiple follow-up and refill visits. To try to help him I saved money myself to pay for that. He has been on medication for a couple of months now and our situation has improved a lot. After he’s heard about this cost increase he’s considering cutting visits with his therapist, and also stopping medication because that is a big economic burden due to all the consultations that that requires. I beg the administration to please not increase copay. I can see how going from $15 to $25 for someone who has a couple consultations a year is not a big deal, but for someone like my partner who needs so many visits to care for his mental health the increase is very significant. We will be paying around $100 extra just on his mental health. A place like Caltech should not cut on mental health care for the students, they could be cutting on free food or many other things instead.

Student #40

Last year I had an abnormal result in a checkup, which necessitated a further visit to a non-Caltech specialist; although I only had a simple procedure done, I paid upward of $100 for the visit. Luckily for me, the procedure yielded a benign result and no further visits were needed; however, if I had needed further care, it would likely have been prohibitively expensive.

Student #41

As a new grad student I have only used the health insurance once when I went to the Caltech health centre and got a cream for my skin. However, I was not referred to a dermatologist because the nurse practitioner at Caltech thought they would only write very expensive prescriptions. Due to the nurse practitioner having limited knowledge about skin problems I felt quite let down by this to the point that I consider going to a dermatologist back in Norway where I wouldn’t have these concerns.

Student #43

I don’t use the student health center anymore because I found the quality of care to be lacking. I also have a dependent whose insurance is only slightly subsidized by Caltech, and they are not eligible for the student health center. I always reach the out of network maximum for both of our accounts because the insurance company will fight tooth and nail to charge everything as out of network except the primary doctor’s visit (all tests that are sent to other labs, all treatments in hospital, etc), and I don’t have hours to spend fighting them to get the slightly better price. This is a huge portion of my family’s income, and Doug Rees’ email asserting that our student healthcare costs only comprise a very small percentage of our stipend–which completely ignored the fact that anyone who actually uses their healthcare ends up paying much more than the baseline price of the plan–was insulting.

Student #44

As it is, I cannot afford to see a therapist who is truly effective for me, because he is out of the UHC network. I was able to set aside enough money while I still lived in the cats, but after having to move to more expensive private housing, this option is no longer available to me. Nevertheless, the mental health coverage of the current plan covers the costs of an in-network provider quite well – I see a therapist once a week. However, the proposed changes to the healthcare plan will place significant financial strain on me. If I see a therapist once per week, with 12 covered visits and a copay of $25, I will pay about $900 in the 2020-2021 academic year just in copays for mental health, not even counting other changes to the plan. While the minimum stipend is being raised, I was under the impression that this increase was meant to offset the ever-increasing cost of living in Pasadena. $900 is a significant portion of the pay increase, and I expect my rent to go up as well. I therefore expect this new healthcare plan to significantly impact my finances, and worry that it will preclude my access to the care I need.

Student #46

I’m unable to get off campus therapy because I’d have to pay 1,000 out of pocket before it was covered

Student #48

I often reach my out of pocket maximum, and need to visit the doctor often, so I am impacted by the rising annual premiums, office visit copay, and out of pocket max.

Student #49

I am relatively new to Caltech and was on my parents health insurance prior to coming. During that era I had a few minor surgeries (tonsils, cysts), the bill for each of which came out to more than $5000. Now living on a graduate stipend, I am very conscious that I am in no position to afford a medical bill like that, much less the out of pocket max on the student insurance, and I pray and pray that I remain healthy during graduate school or am able to delay any major surgeries until I am earning a professional salary.

Student #51

Due to healthcare costs, I have not been able to get necessary physical therapy. I currently have FAI and bicep tendinonpathy so I have trouble walking or standing for long periods and carrying objects over a few pounds. This leads me to feel outcast. A 22 year old male should be able to walk and carry everyday items without pain the next day. A visit cost $400+ with insurance and the deductible means I need to significantly plan for it. Even with 80/20 coverage, I am left with a ~$100 bill and typically treatment plans have one visit 2 times a week for 12 weeks.

I know I need MRIs to see if I have degenerative tendinonpathy, as I was recommended by a doctor, but I can’t afford it. This will just be something I have to deal with for the rest of my life because of unafforable healthcare.

To cope, I read anatomy books and physical therapy books to learn myself, but there is only so much I can do with studying and researching full time. I feel like it’s an all-consuming issue. Every time that I walk or stand, I can see the imbalances, I can see my muscles tightening in the wrong way and I can envision by hip capsule wearing down, which leads to this becoming a permanent de-formative issue. But, the administration needs to save money, right?

Student #52

When I was a first year grad student, a routine dental checkup found several cavities that a previous dentist had missed. I ended up being on the hook for nearly $9000 in follow-up oral surgery and costs. I was on my mom’s healthcare/dental plan at the time, which covered $2000 of those costs (Caltech’s dental would only have covered $1500 at the time; this value is probably lower now, since benefits have since been reduced). I applied for emergency funding from the Grad Office, which I understand is intended for just this sort of “significant unanticipated expense.” I was given $2000, which is pocket change compared to Caltech’s $3 billion endowment but still left me with nearly $5000 (almost 4 months of rent!) in out-of-pocket expenses. I am privileged enough to be in a financial situation where I was able to recover, but for the majority of graduate students this is a monumental financial burden.

Student #53

I never use healthcare because it’s too expensive. It’s nearly free in Taiwan.

Student #54

The largest concern that I have is in regard to the decrease in healthcare benefits (in particular, the mental health care benefits) for graduate students in the next health care cycle. Although the administration aims to ameliorate this by increasing our stipend by approx. ~$1500, this does not fully compensate the proposed decrease in benefits. If our waived behavioral health visits are decreased by more than 50%, graduates students who depend on these will be obligated to seek this service elsewhere, which will likely result in a greater out-of-pocket expense. Caltech grad students take pride in the above average mental health care benefits for graduate students (relative to our peer institutions), which is in part used as an incentive during grad student recruitment. This is in part, due to the convenience (both fiscally and in terms of time) of being able to regularly attend therapy through the health center. Any decrease in these readily available resources could greatly increase the so-called activation barrier in terms of getting students to actually go and seek the help he/she may need.

Student #56

Yes, for something as ridiculous as a prescription refill, my doctor asks that I visit his office. If the copay cost will increase to $25, that will be ($25 + difference to meet the new increased $500 deductible) just to get my pain medication. This compromises my health as I will now be less inclined to take my medication, since as a graduate student, I am in no position to spend up to $200-300 just for a prescription refill.

Student #58

I haven’t hit the out-of-pocket maximum because it is too expensive, but I would have if I had the money to spend on my work-related injury

Student #60

Asking Kevin Lee for help is even less transparent than the whole insurance process. He is a very unhelpful person, very non-responsive and unable to explain me what the deductible was or what offices were in-network. I know you guys cannot change that but I just needed to rant.

Student #61

Care provided by Caltech Health Center is abysmal. Have had such weird experiences with the nurse (Edith Montes) who has been rude on numerous occasions. Alice is also really touchy. Collectively everyone has mis-diagnosed or left me un-diagnosed numerous times, recommended expensive specialists that don’t help, etc.

Student #63

I am outraged and disgusted at Caltech. SHAME ON CALTECH. If Caltech is going to put us in a high pressure, stressful environment, it is the very least they can do to give us mental health care. I used to tell undergrads I knew apply to grad school to apply to Caltech, now I tell them not to come here because this school doesn’t care about grad students at all.

Student #66

I just want to say that the raise in copays will impact the most people going to psychological counseling, and will maybe make some of them avoid their needed visits. This is unacceptable at a high-pressure environment such as Caltech. The administration should do something to prevent people not cutting on their mental health visits.

Student #67

I use the services of a therapist, and she helps a lot to manage my anxiety. I see her every two weeks, so about 26 times per year. I am afraid that the proposed cuts will impact how many times a year I can see my therapist while being covered by the health insurance plan.

Student #69

Rather than use health insurance, I have opted to pay for things without insurance, as the cost is almost the same. It’s very unfortunate, but these are the times that we are in.

Student #71

I experienced a concussion that left me with post concussion syndrome (difficulty focusing, easily fatigued) that ended up lasting at least one year. I was referred to a neurologist by the Caltech clinic, and this neurologist suggested that I undergo a neuropsych evaluation that might help me determine which aspects of cognitive function were affected and provide strategies for rehabilitating those functions. But this neuropsych evaluation was out of network and cost $3500, so with the 60% out of network coinsurance, it would have cost me $1400. I chose not to undergo this evaluation due to cost, and it likely delayed my recovery and made doing research much more difficult for some time. My adviser was very understanding while I was dealing with the worst of the symptoms, but if I had been able to afford the procedure, I would have felt like I had a better grasp on my condition and knew how to rehab properly.

Student #73

I will not go to doctors even if i get the coronavirus. I rather risk dying in my room in the cats. I cannot believe insurance companies are trying to make more money off of us even as we need better and more affordable healthcare. We are already crowded into small apartments just to afford rent and this already increases our risk of contracting illnesses. People are dying and healthcare executives are trying to make a buck so they can retreat to their island vacation homes. WTF

Student #74

Causes a lot of background stress that if I have an accident/become ill and have to visit the hospital I’ll go into debt.

Student #75

I have not been impacted, but I will be impacted by a decrease in the number of covered mental health visits.

Student #76

Almost didn’t use my insurance, a bit concerned about rising costs

Student #77

I suffer from a number of chronic physical and mental health conditions, some of which have worsened due to grad school. To properly take care of my health, I would need to go to regular psychotherapy in the long-term, and weekly physical therapy in the short-term. Because of current cost and lack of suitable in-network services, I have not been able to do this. Every day I do my research while experiencing physical pain. Working longer makes the pain worse. This, on top of the regular stressors of academia, has made me seriously consider dropping out numerous times. It is only because of the support from the community my friends and fellow grad students have made, that I am still at this institute. Like many grad students in California, I have high rent that rises every year (more than my stipend) and student loans to pay back. These healthcare increases are not manageable, and will harm Caltech’s most vulnerable disproportionately.

Student #78

I am concerned about rising costs. I regularly see a psychologist and get allergy shots, and having copays go up would be very stressful. I want to be able to feel that I can afford my regular care and any emergencies that come up.

Student #2

I haven’t been impacted, but worry I might. The proposed changes to the deductible and the out of pocket maximum are extreme.

Student #3

I am a student who suffers from anxiety. Furthermore I am at risk for serious health complications or death from COVID-19; during this global pandemic and economic recession my family and many other families have a severely reduced income and face possible eviction and homelessness. While I am doing my best to financially support my brother and my mother, father, and grandparents during this scary time, Caltech has decided via an utterly inaccessible and opaque process to cut my health insurance benefits. It is not only difficult and stressful but it is also incredibly terrifying to have to worry about what caring for my health will mean for my finances.

Student #5

I can no longer go to physical therapy for my hip because I have now reached my limit for my number of visits and can not afford to pay out of pocket for it. I have also had to change where I go for certain things because of the insurance change. I will have to have surgery and I am unsure how much it is going to cost because of the insurance we have even though it is non-elective.

Student #7

Last year, the Health Center referred me to a pulmonologist. They recommended a test that, due to the $250 deductible, I would need to pay almost completely out of pocket. This was a big economical burden but I decided to take it for the sake of my health. Turned out I have a condition that was luckily detected on time. If this had happened this coming year, with the $500 deductible, I could not have afforded it and would have put my health at risk for economic reasons. Caltech is putting their students at risk, and with these coming times it is going to be even worse. I am honestly scared about this situation and the cuts only make it much worse.

Student #9

(Sorry in advance if these numbers are wrong. I’m going based off my memory when I last looked into this)

I go to off-campus therapy weekly and have enjoyed the benefits of 25 free visits (after those first 25 visits, I started paying the $15 copay for each visit — this will amount to me paying ~$360 out of pocket by the end of this year. I already thought that this was a lot of money for me to pay for my therapy sessions). So if this number of free visits is cut down to 12 and the copay is increased to $25, as proposed in the new healthcare cuts, then that would amount to me paying ~$900 for therapy for the year. That is absolutely insane for grad student with our stipends to pay that, and I would probably cut down my weekly visits to every 3-4 weeks, rendering therapy much less effective. I think that these less frequent therapy visits may be reasonable for someone who’s been going to therapy for a long time, but the new costs would really create a high barrier for someone who wants to get into therapy for the first time, and they’d probably be discouraged from pursuing therapy long-term even if they needed it.

Student #11

For the first two years of my graduate studies, I was particularly hesitant to seek health care beyond the Caltech health center (even though it was necessary) because I was concerned about the financial burden. Recently, due to a flare up of an old back injury, I had to see several specialists and physical therapists, including getting corticosteroid injections in my lumbar spine. The cost of that visit alone, after all healthcare benefits that Dean Rees thinks are appropriate in the current plan, was $900!! I have met the $1500 out of pocket minimum twice in the last four years. While I spend time recovering from my lower spine injury, I will have to continue physical therapy, which with the proposed cuts in our healthcare plan, will cost a lot of money and stress.

Student #13

Last summer, I went to the ER once to test if I needed to get appendectomy because I felt acute abdomen pain. Afterwards I received a bill of $1700 after insurance coverage, which was a huge burden for me. Actually the original bill is $17000. So I cannot imagine if our health insurance changed, how much I will pay for such a case.

Student #15

I had spinal surgery in college and was hoping to continue physical therapy during my PhD here. Since Caltech does not have a medical school, I have to visit the clinics outside. I also do not own a car, but the closest clinic is out of network, which means higher deductible and higher copay, let alone travel costs. After a few visits, I felt the charge is just way too high. With the insurance we are paying every quarter, getting physical therapy essentially creates extra expenses, until I reach the ridiculously high, ever-increasing out of network deductible. I live paycheck to paycheck (like many other grad students) and do not have family in California, so it has been extremely difficult. After the increase in insurance cost last year, I decided to stop going for physical therapy visits to save money for other essential expenses. Even though my condition is stable right now, not being able to receive regular physical therapy restrains me from doing almost any sports. It is embarrassing when your friends ask you to join the baseball team when you just cannot play baseball anymore. I also constantly worry that some random accident will make the condition of my spine worse. I cannot even image the associated medical bill for future surgery if I need one. All of these just make it so hard to focus on research. At the end of the day, I can survive without physical therapy for now, but I am basically doing grad school at the cost of my physical health that will almost definitely takes me down one day.

Student #17

I need to see a therapist 3 times a week and I recently started going to a psychiatrist for medication for depression. The copay is already hard for me to pay, but the increased one is going to make it impossible for me to afford. I will need to cut on my mental health visits if the coverage changes become reality.

Student #19

My doctor considered I should take a Home Sleep Study because of my poor sleep and my breathing issues. However, I cannot afford it because of the current deductible. My idea was to save some money and get it done, but with the deductible increase I think I won’t likely be able to take it anytime soon. I will have to deal with my sleep problems for a while because of these cuts.

Student #20

Ever since I joined my research group I suffer from anxiety. It got to the point where I would have a panic attack almost every night. I went to the Counseling Center and they referred me to an outside provider. I see my provider twice a week – I could not get away with less to get my anxiety under control. I finished the first 25 visits after the first three months, and I’ve been paying $15 per visit twice a week, so an average of $120 on mental health a month. I think this is already super expensive and it is making me reconsider therapy at times (even thought it really has helped with anxiety). With the new proposed changes I would have to pay $200 a month. I really cannot afford this, I’m already struggling to pay $120. Plus I have other medical expenses that I need to consider.

Student #23

Last year I was dealing with a medical problem that was really scary, and I went to specialists (referred by Caltech) multiple times to try and assess the situation. I didn’t realize how expensive it would be because I hadn’t really used the health insurance much before then. After I did, I decided it was worth it to take my chances and not see anyone about it again, because it would become totally untenable to pay for after a few more visits. It was one of the worst months of my life. I still don’t know what will happen–will this problem re-emerge?–because care was too expensive at the most critical moment. And it’s getting even more expensive this year.

Student #25

I recently went to the dermatologist for a mole checkup and they said I should have it removed because it looked like skin cancer in the early stages. I asked how much it was going to be and they could not answer. I asked the person in charge of student benefits and he also could not answer. I went to the insurance website and I found an estimate of $300 because I haven’t hit my deductible yet. I decided to wait until I go home in the summer and have it removed there. Now with this new COVID-19 situation I will clearly not be able to go back, but I also don’t have the money to do the procedure here. I was reasonably calm waiting a few months, but if it is really cancer I cannot wait for a year. I only heard about the emergency fund at the town hall, but will that work for this situation where what I have is not really an emergency? And this is only with the actual plan, I cannot even imagine how many situation like this there will be if deductible raises to $500. My intervention will be even more unaffordable in that case!

Student #28

I have a surgery planned which I plan to delay to limit my out of pocket expenditure. It is not the most urgent surgery and therefore i can delay it but it causes substantial discomfort.

Student #29

As a grad student that is supporting dependent children, the premiums for purchasing healthcare for my entire family is $2909/term or $8727/year (meaning about 25% of the minimum grad student stipend)! With living in Caltech’s family housing for grad students taking up about 50% of the minimum grad stipend, we have nearly nothing left for other living expenses (such as utilities, dental and vision insurance, food, transportation). This is not in any way affordable for the only twenty or so students with children.

Because of these financial constraints, my family (and other grad student families) must use MediCal (California’s free welfare health insurance for low income individuals). Unfortunately, the quality of care is significantly lower because MediCal does not pay doctors as much, meaning we are, in essence, limited to visiting doctors that are unable to attract or retain patients with private health insurance. For these reasons, my spouse and I have not had any (except emergency) medical visits in the four years I have been at Caltech and our daughters are experiencing sub-standard care.

Student #33

Often the provider I want to go to is out of network, so I am forced to choose between a less ideal provider or paying more. This is especially concerning in light of the rising deductible and out-of-pocket maximum for the out of network providers.

Student #35

I have had a pain on the right side of my abdomen for a few months. I went to the health center and they said I needed an ultrasound. I was unable to know how much that was going to cost, but since I hadn’t hit my deductible yet I figured $250. I was saving for two months to get the money and I finally went to an off-campus office to do it. They discovered a cyst on my ovary that needs to be removed. This intervention will put me in the max out-of-pocket limit. I was very concerned about how I am going to pay for this, but not only that, now with the coronavirus situation they have cancelled all my appointments. I will most likely need to wait until the fall, so the new cuts will already be in place. Not only I spent $250 in deductible that are now going to go to waste, but now in order to continue the process I will need to pay $500 more for the same intervention according to the new cuts. Not only our health is being impacted by the current shutdown, but also these changes going in effect in September put those of us needing interventions at a great economic burden. I am paying for an insurance that I’m unable to use this year because of the shutdown, and on top of that they cut coverage so those same procedures that I cannot do at this year I need to pay them at a higher rate next year. This is so unfair and so non-considerate from Caltech. We should get protection in this pandemic, not be the ones who pay for it!

Student #37

I have used all my mental health visits last year and plan to do so this year. It has been an incredibly important part of maintaining my mental health. This has helped me be able to function as a person and specifically as a graduate student, a situation with inherent stress. I’ve also had multiple injuries due to physical activities that are also important to my mental health. While I was able to keep most of my expenses in network, hitting the maximum is still a large financial burden. Luckily, I have felt empowered to use the Caltech Emergency Fund. I knew about the fund, vaguely how it worked, and had people advocating for me. Despite this leg up, it was still really stressful waiting for the bills to come in and not knowing if I would be stuck with them or receive any help. The process is not transparent enough – you cannot be sure if you will receive any help. It seems like the budget fluctuates or just changes based on who is applying for help, which is wild. If you are going to offer the Caltech Emergency as a stop gap, then it should help everyone equally – certainly not the case right now. Finally, I had an issue with my physical therapy one year where the place I was going to changed from in network to out of network while I was going there without my knowledge. Luckily, this got remedied by the insurance company, but it was a huge wakeup call to the expense of using out of network healthcare and how easily it can happen, even when you do your research ahead of time. The fact that the out of pocket max for both in and out of network would increase to beyond one month of pay is a crazy financial burden that no graduate student should have to face. I think the institute has a responsibility to take better care of its students who are the backbone of research.

Student #39

I have to go off campus to get necessary mental health care, which already costs me hundreds of dollars a year in copays. Additionally, I’ve recently been diagnosed with a genetic connective tissue disorder, for which the few specialist physicians are outside of our insurance network. Once the pandemic has eased up, I’ll need to pursue primary care and physical therapy to manage chronic pain, dislocations, and other health issues, all of which will be subject to out of network copays and the deductible and out of pocket maximum. I could see my yearly healthcare costs go up by thousands of dollars under the proposed changes.

Student #42

I had an emergency medical expense that was covered fully by Caltech’s emergency fund. While incredibly generous and helpful to me, this process concerns me slightly: if this fund runs out, or if I had not known about it, or if I had not been comfortable sharing my medical circumstance with the dean (I was), I would not have gotten that coverage. This system thus benefits people who ask for help–and, as written by Shampa Biswas in The Chronicle of Higher Education article titled “Advice on advising: how to mentor minority students”, March 13 2019: “It is easy to forget that first-generation, minority, and foreign students can be very intimidated by college professors — and less willing than other students to seek out our advice.” Or, I would posit, help. Accepting that, then the system at Caltech (rather than a system that covers these expenses in the first place) is preferentially benefitting those who are already privileged, and leaving behind those who are already structurally oppressed in the USA (and presumably at Caltech). My question at the end of this experience was, how are these case-by-case decisions made–do they benefit certain types of emergencies deemed worthy, but not others? Isn’t that the role of health insurance–to cover medical expenses in a pre-determined way that is clear to the purchaser of the insurance plan (e.g., one knows how much of an emergency cost will be covered in advance of having it)? While, for me, the system of the emergency fund was truly helpful and I appreciated it deeply, as it sheltered me from unaffordable healthcare–which, under most other insurance plans within the US would also have been unaffordable, to say the least–I worry that not all students have the “courage” that it takes to ask for help, or the clarity to advocate for their case and why their emergency deserves the funding. That creates a scary feeling for those who are trying to get support in times of emergency, of need. Caltech is in a position where they try to prevent this by offering the emergency fund; why not be a leader in the arena of social justice in higher education, and do so by providing health insurance coverage that does not leave room for those in the most need slipping through the cracks?

Student #45

I am concerned about the rising cost of healthcare in this country. I am fortunate enough to be healthy and not have to worry about recurrent hospital visits. However, seeing the rise in deductibles and premiums is disconcerting. It makes me worry that I will not be able to afford an unexpected, emergency visit to the hospital. This is especially true given that I already have a considerable number of expenses each month: non-subsidized rent, healthcare, car and bills/food. Like many students at Caltech, a continued rise in healthcare costs is something I simply cannot afford in the long run.

Student #47

Financial and psychological stress of having to go to a doctor outside of Caltech: uber/lyft to the doctor and back, pay copay, get a huge bill. Every single time I have to visit is painful on top of the illness itself. I appreciate having the health and counseling services here. I think they are great, but very limited in what they can do on site.

Student #50

I have two very long stories ahead, but first I should say that I’m graduating this term and the new changes won’t affect me.

First story: I have consistently struggled with mental health through my entire six years of grad school (content warning for the rest of this paragraph). After seeing the counseling center for around six months, I started self-harming (which is something I had never done before grad school) and the counselor referred me to an outside therapist in Pasadena. I was on my parents’ health insurance at this point and they had Kaiser. I couldn’t find any therapists that took Kaiser so at this point I decided to switch to the Caltech insurance. I was very lucky in that my new therapist diagnosed me with a “severe mental illness” which under our insurance is 100% covered if the therapist is in-network. I have never paid for therapy with this particular person in the four years I’ve been seeing her, which is one very good thing about the Caltech student insurance. Unfortunately, weekly talk therapy wasn’t really enough support for me. In 2017 I got about halfway through a suicide attempt, but I stopped and checked myself into the psychiatric hospital before I could go through with it. When I checked myself in I called my parents and my dad insisted that the hospital send the bill directly to him, so I have no idea how much it cost. Las Encinas in Pasadena is in-network for us, but I know that my two-day stay still cost at least a couple thousand dollars (although my dad refuses to tell me exactly how much). I had many more partial suicide attempts over the years but I hid most of these from my friends and therapist so that I could avoid being sent to the hospital again. Part of my (very bad) reasoning was that it was a miserable few days in my life but mostly I didn’t want my dad to end up with another huge bill. Last spring, my therapist diagnosed me with borderline personality disorder and I decided to enroll in a treatment program specifically for this purpose in Sierra Madre. This ended up being two hours per week of group therapy, for one year. The program was out-of-network, and there wasn’t an in-network alternative, so I ended up with a $2400 bill after insurance (in addition to a $1500 medical bill that I’ll go into later). This was way too much for me to afford and my parents couldn’t help me out this time because my mom had just lost her job. I applied for the grad office emergency fund but they could only give me $1000. Nobody told me that this fund was taxable and that taxes would be withheld before I received the check, so I think I only ended up with about $800. I finished the program last month and I’m still in debt.

Second story: I have a congenital defect in my vascular system, that’s mostly harmless long-term but causes me a fair amount of pain, and has my whole life. It’s gotten a lot worse in the last few years, and every couple weeks I was in so much pain that I couldn’t even really work for most of the day (the defect is in my dominant forearm so I had trouble writing and typing, as well as just driving to campus). I found a surgeon at UCLA who specializes in this particular condition, so I started going to him for monthly injection treatments. The UCLA health system is in-network for us, so these treatments are 80% covered. Still, the equipment they use is so expensive that I ended up hitting my $1500 out-of-pocket maximum on the first one alone, and I’ve done about 12 at this point. My parents and the grad office were able to help out with this one, but I started the mental health treatment program a few months after that so I had about run out of help at that point.

I’ve lived alone off-campus for all of grad school, and I realize that this is my own choice but with the rising cost of rent in LA I have never been able to accumulate any savings and am now several thousand in debt from medical bills. I was very lucky that my parents were able to help out a lot, but many grad students don’t have that privilege. I’m starting a much higher-paying industry job in June so I should be able to pay off my medical debt within a few months, but grad school has still been a huge financial struggle. Last year I had to move out of Pasadena because my rent went up and I couldn’t afford to live there anymore. I had a hard time finding housing at all just because my credit was so bad from all my medical debt.

Student #55

Increasing premiums, deductibles, copays, AND out-of-pocket maximum all at the same time is unreasonable! There are procedures that I had scheduled, which had to be canceled due to the pandemic, which will likely delay them until the start of the next insurance cycle, resetting all the diagnostic costs I already had to pay, reaching the out-of-pocket maximum, to have to pay all of that and more come September. Please, at least keep one of these costs at bay, and relieve some of the financial burden it will cause us.

Student #57

I may or may not have fractured my arm after a GSC iceskating event in 2016 – I never found out because when I went to the Caltech health center I was told getting an x-ray and any further medical advice wouldn’t be worth it unless I had already hit my out of pocket maximum. Subsequently I couldn’t move my arm for almost a month, and really regret not getting a proper evaluation and the correct PT to treat my arm.

Student #59

I think it’s awful that Caltech cuts on mental health (and cutting on copays is cutting on mental health because let’s face it, if it wasn’t for therapy raising copay $10 would not really impact my finances unless I had a chronic illness). Also, mental health needs are in most cases induced due to a terrible advising situation and other circumstances directly related with life at Caltech, so Caltech should feel responsible for this and help us afford our mental health needs.

Student #62

I would much rather pay the entire premium increase myself than having cuts to coverage. Please do not let them cut coverage, it is very much needed among Caltech students!

Student #64

I had a medical emergency and could not find any local in-network providers that were open at the time that I needed medical attention, so I was forced to go to an out-of-network provider, thus costing more and adding more stress to an already stressful situation.

Student #65

I used to see a therapist. 25 free visits help, but are far from being enough for someone who requires therapy for other than a temporary crisis. That is why, raising copays is so dramatic, it affects very much to people with mental health issues that visit therapy once or twice a week. I haven’t done the numbers, but raising $10 each visit will certainly have a big impact in many student finances. The worst thing about this is that many of them will decide to cut on visits, making their situation worse and in turn compromising their mental health and their ability to work. In such a place as Caltech I cannot understand that they don’t prioritize mental health much more.

Student #68

For most care I am not charged a copay, but rather 20% or 40% (in/out of network) of the total cost of the services. This is a lot of money.

Student #70

This is an overwhelming hike in the insurance cost; especially I barely use my health insurance because I almost never visit a doctor. The only time I have visited Caltech’s Wellness Services was at the beginning of the spring term to have a prescription for a Vaccine which was mentioned mandatory to me for the sake of registration. But I have never used it personally. So this is going to be an unnecessary burden; especially the increase in the deductible is absolutely redundant; I completely disagree with this. In case I indeed use the plan then some increment in the “out-of-pocket maximum” may be acceptable; but still the amount of increment in this regard i.e. $500 is unreasonable.

Student #72

I’ve been pretty frustrated with Caltech’s health center, especially the 15 Caltech promotes this as the first-stop for students seeking primary care.

During my first year, I asked for a routine checkup from the health center. The attending nurse seemed very confused by my request and made it clear that it was unusual for students to come to the health center seeking a routine physical exam. However, I was not advised at this time to seek an in-network primary physician outside of Caltech’s health center.

During my third year, I requested that I be tested for Hashimoto’s thyroiditis, a thyroid condition that typically presents as normal or slightly hyper-thyroidism early in adulthood. This is a genetic condition that all members of my nuclear family and much of my extended family has, so it is very likely I have this condition. It is good to identify and treat this early, as it leads to more disruptive thyroid conditions later in life. Despite explaining this at the health center, I was given a general thyroid panel and told that my thyroid functioning was normal and I don’t need to worry. Unfortunately, this panel did not include the type of test that would have been necessary to identify early stage Hashimoto’s. At this point, I decided I needed to seek advice from an outside physician, but unfortunately was not able to get tested before the COVID pandemic.

I’m very concerned about the cost increases proposed. In particular, I always hit my deductible, and would expect to hit the new, higher deductible. I also have frequent (currently 2/week) appointments with mental healthcare providers, and would be significantly affected by the copay increases (not to mention the additional costs if I add in some acute health problems, as happen from time to time).

I’m particularly frustrated by the seemingly intentional obfuscation by administration about our healthcare costs. Every year, Caltech publishes an estimate of cost of living for graduate students. Caltech says this budget is part of the official basis for determination of financial aid. However, despite increasing fees for healthcare, room, and parking for the 2019-20 year, Caltech’s official budget does not reflect these price increases. Instead, Caltech only increased its estimate of grad student board expenses, falsely claiming our cost of living in other areas remained the same. This amounts to a pay cut. If Caltech wants to continue paying grad students bare cost of living rather than an amount proportional to our value-added to the Institute, the least they could do is estimate those costs in good faith. The stipend should be raised dollar-for-dollar to cover every fee increase Caltech passes to grad students. Anything less flies in the face of their own framing of our stipends as intended to cover our bare cost of living.