Credit: G. Grullón/Science

The California Plan

Americans with health insurance generally get it where they work, and people doing the same job at the same organization usually get the same benefits.

But not postdocs. Colleagues working in the same lab often have very different health care options, some receiving the same high-quality group coverage that faculty members get, some limited to lesser plans at higher cost, and some forced to buy their own insurance on the private market. That's because it's the source of a postdoc's funding, not the work he or she does, that determines access to health coverage.

Now, however, the University of California (UC) aims to end the confusion and inequity with a new policy promising each of the 5200 postdocs in the 10-campus UC system access to the same group health coverage. "It is our intent to have one set of benefit plans for all these individuals," says Jean Fort, assistant vice chancellor for research at UC San Diego and chair of the systemwide consortium that spent 6 years revamping the policies regarding postdocs. The coming months will tell whether the policy is feasible in cash-strapped California and whether it is applicable to other universities across the nation, many of which are also struggling to provide reasonable benefits to all their postdocs.

Promulgated on 1 July, the new plan is "the first in the country," says Sam Castañeda, coordinator of visiting scholar and postdoctoral affairs at UC Berkeley and a member of the systemwide committee. "The rollout of the benefits has been so complicated" across the vast system, however, that the insurance plan is not slated to go into effect until 1 January 2004, he says. In the meantime, "we've given all the campuses time to prep themselves" for the change.

According to Fort, the "major goal is to have as consistent treatment as possible for these individuals, because they're all here for training, they're all working side by side, [but their] status has been a function of funding." Until now, funding-agency regulations divided postdocs into three "buckets," Castañeda explains. "Bucket one is an employee postdoc," who receives a salary from the university paid out of a professor's research grant. "Bucket two is a stipend postdoc," who has a fellowship, often from a federal agency, that passes funds through the university's financial system. "Bucket three is a direct-pay postdoc," who holds a fellowship from a private agency that is paid directly to the postdoc rather than through the university, usually making him or her "invisible" to the campus bureaucracy.

"The [employee] postdoc gets free health insurance" and all other regular employee benefits, Castañeda continues. The stipend fellows in bucket two cannot receive employee benefits because federal funding agencies do not permit them to be considered university employees. Many schools run special health plans for stipend fellows, but the research allowances that accompany many fellowships, which are intended to defray ancillary expenses such as fringe benefits, generally fail to cover the full cost. Departments often make up the difference, but as nonemployees, stipend fellows must declare departmental contributions as taxable income. And if the department doesn't pay, the fellow must.

The private-pay fellows in bucket three don't "even exist to the university" and are on their own regarding health insurance, Castañeda says. That can cause mix-ups, such as the day at Berkeley when "you have the fire drill in the building, and the postdoc breaks his ankle. He goes to our health service and says, 'I'm a postdoc.' And they say, 'I'm sorry, we don't know what you're doing here or who you are. Go to the public hospital.' "

Under the new policy, UC has created a new bureaucratic category, called "postdoctoral scholar," that includes all three buckets of postdocs. Unlike the former categories, status as a postdoctoral scholar depends not on an individual's source of funding but on having received a postdoctoral appointment of any kind to work on research under the mentorship of a faculty member. Postdoctoral scholars will no longer be eligible for the university's general employee health plans. Rather, all UC postdoctoral scholars appointed after 1 January 2004, regardless of their funding source, will enroll in a new, uniform postdoc health plan that will offer coverage comparable to the employee plans. Special arrangements for stipend fellows will be terminated. Postdocs enrolled in an employee health plan before 31 December 2003, however, will get to choose between staying with their current coverage or switching over to the new one.

A single plan for postdocs will be "wonderful, for this important reason: A lot of postdocs change funding every 6 months" and thus have also had to change insurance plans, Castañeda explains. And with the UC San Francisco campus just 15 kilometers away, "we have a lot of people who transfer from UCSF to Berkeley, and the health insurance [on the two campuses] is [as different as] day and night."

The new plan's specific benefits have yet to be determined. "We're going out to bid in the not-too-distant future," Fort told Next Wave in early July. "We're asking for brokers to work with carriers to propose [plans] to us." Each participant will get a choice of "at least one HMO and one either PPO [preferred provider option] or point-of-service option," as well as vision and dental coverage. But because of the state's great size, as well as "some differences in medical care provisions in northern California compared to southern California," the final package may include "this HMO in southern California but that HMO in northern California," she explained. Or, perhaps, carriers may cover "clusters of campuses. [Or], it may turn out to be ... the same plan for everybody. We just don't know yet." But she believes that "the cost will be no more than [that for] the current employee plans and [probably] somewhat less, because this is basically a younger, healthier population."

It's unlikely, however, that all its postdoc participants will pay the same amount, at least in the beginning. "Our long-term goal is ... a uniform contribution by the university for all postdocs," Fort says. "But that is not achievable immediately. ... We're going to be working [toward having] the agencies that are funding [fellows] cover these costs. But even NIH is not providing enough money in ... their [research] allowances ... to cover the cost for families."

To lower the cost to stipend and private-pay postdocs, "campuses can supplement from discretionary funds if they're able," Fort adds. "A lot of them would like to," but California's gigantic budget shortfall makes that unlikely. So, despite all belonging to the same health plan, UC postdocs in the three different buckets will still be paying different amounts for their health coverage for some time to come.

Even so, the entire UC system now has "a unified policy that covers all postdocs irrespective of funding," Fort says. "Here's the big deal," adds Castañeda. For the first time, "every bucket of postdocs will get health insurance."

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