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New poll of CSU students indicates that when it comes to purchasing insurance, “affordability,” not “invincibility” is the problem

February 3, 2014

Results from survey conducted by Cal State L.A.’s Department of Public Health reveal strong link between income and insurance status

A new poll released today by the Department of Public Health at California State University, Los Angeles found that 30 percent of students in the California State University (CSU) system may be uninsured and that the primary reason for being uninsured is the high cost of insurance.

The poll was conducted at three CSU campuses (Fresno, Los Angeles, and San Jose) as part of the CSU Health Insurance Education Project (HIEP). Current enrollment in the CSU is 437,000. With 23 campuses, the CSU is the largest and most diverse university system in the country.

HIEP is housed at Cal State L.A. with the support of the Office of the Chancellor. The goal of the project is to educate students in the CSU system about their new insurance options under the Affordable Care Act (ACA). The project is funded by a grant from Covered California, the state agency tasked with implementing the ACA in California.

Almost 80 percent of the students reporting themselves as uninsured responded that they did not have insurance because they could not afford it, while only 7 percent reported that they “did not think they need it” and only 2 percent reported that they “did not want it.” Four percent reported that they want it but had been rejected.

All the students polled were asked which point of view they agreed with most. Seventy-three percent responded that they should have insurance to make sure they have “access to care if I need it.” Another 19 percent chose the viewpoint that having insurance was the “responsible thing to do.” Only about 5 percent said “I don’t think I will need it” or “I can always go to a clinic or public hospital.”

According to Walter Zelman, the department chair and director of the education project at Cal State L.A., these results indicate little support for the widely-touted theory that many students think they are “invincible” and thus feel they don’t need insurance.

“Most students may be in good health, and when compared to older individuals, insurance may not be high on their priority list. But, they know they need it. They just have not been able to afford it. This is not about invincibility; it is about affordability,” he said.

The poll results also demonstrate a strong connection between access to health insurance and income. Students with lower incomes are far more likely to be uninsured.

About 59 percent of all dependent students reported family incomes of less than $50,000. Among dependent students who are uninsured, that figure was 82 percent. Fifty-eight percent of financially independent students reported incomes of less than $15,000. Among financially independent students who are uninsured, that figure was 80 percent.

The link between access and affordability can also be seen in results denoting what students were willing to pay for insurance. That amount is far below the actual cost of the insurance in the pre-ACA marketplace.

Seventy-three percent of all students and 85 percent of uninsured students reported that the most they would be willing to pay for health insurance, per month, was $100 or less (the lowest option listed in the poll). Insurance costs posted on the Covered California website for the central Los Angeles area show that even the lowest-price Bronze plan costs $154 per month, before government subsidies, which is at least 1.5 times what students report is the maximum they would be willing to pay each month.

“Given what we know of the relationship between income and insurance status, it should be no surprise that the number of uninsured students in the CSU system is as high as it is,” Zelman noted.

Based on CSU financial data, approximately 35-40 percent of CSU students (2011-12 data) and many family members may be eligible for Medi-Cal. Also, approximately 70-75 percent of CSU students live in households with incomes of less than 400 percent of poverty—the cut-off point for government financial assistance in the purchase of insurance. (Note: Those with access to affordable employer-sponsored insurance are not eligible for government subsidies in Covered California).

Fortunately, Zelman said, several key provisions of the ACA will make insurance far more affordable to CSU students and their families.

  • The expansion of Medicaid (Medi-Cal in California) to include low-income, childless adults. This provision will open Medi-Cal to thousands of CSU students who are low-income and do not have children.
  • The generous financial assistance to lower-income individuals who purchase insurance through Covered California. For many CSU students and families, health insurance will be discounted as much as 90 percent.
  • The provision allowing young adults to stay on their parent’s insurance policies until they are 26. More than 80 percent of CSU students are 25 or younger.

Zelman said that the most important message of the poll is that many students should be willing to purchase insurance once they understand more about it, what they will be getting, and at what cost.

“They know they need it and the once unaffordable should now be affordable,” he said. “Our greatest challenge is getting their attention. Between school, work, family obligations and a modest amount of leisure time, they have many things demanding their attention. Once we have that attention, most should see the value in getting insured.”

For more information about enrollment in health insurance, go to

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Poll methodology

The poll was conducted on three CSU campuses; San Jose (September 9-11, 2013), Fresno (October 1-7, 2013) and Los Angeles (October 19-30, 2013). More than 80 percent of those asked to respond did so. Students were polled on different areas of each campus and at different times in the day. Students were given questionnaires by project employees who identified themselves as representatives of a CSU-supported project.  Respondents were left to fill out the questionnaire, which was then collected. Names of respondents were not requested or collected.

Due to variations in databases and differences between categories in the questionnaire versus categories in CSU data bases, it is difficult to assess the extent to which the sample of students questioned in the poll matches the sample of students on the individual campuses and of the student population of the CSU system as a whole. CSU data provided was for the academic year 2011-12. Financial aid data includes only data on individuals who applied for financial aid, approximately 75 percent of total enrollment.  (See the full poll report for more detail:  

The Cal State L.A. Department of Public Health recognizes that this poll does not meet “peer review” standards, or standards applied by professional polling organizations. For this reason, no effort is made to report margins of error or other statistical measures associated with professional polling. Still, the Department believes the poll accurately captures the general views and circumstances of the CSU student population. Moreover, most of the findings reported entail very high levels of consensus, suggesting that more rigorous polling procedures would probably not have significantly altered the findings.

The poll was supervised by Walter Zelman, chair of the Department of Public Health at Cal State L.A. Zelman received his Ph.D. in American Politics from UCLA. He is also the director of the CSU Health Insurance Education Project. Zelman was assisted in data collection and analysis and chart design by Wendy Lee, a graduate of UC Berkeley, who also serves as Northern California coordinator for the CSU Health Insurance Education Project. Lee completed a one-year post baccalaureate at Cal State L.A.


Working for California since 1947: The 175-acre hilltop campus of California State University, Los Angeles is at the heart of a major metropolitan city, just five miles from Los Angeles’ civic and cultural center. More than 20,000 students and 230,000 alumni—with a wide variety of interests, ages and backgrounds—reflect the city’s dynamic mix of populations. Six Colleges offer nationally recognized science, arts, business, criminal justice, engineering, nursing, education and humanities programs, among others, led by an award-winning faculty. Cal State L.A. is home to the critically-acclaimed Luckman Jazz Orchestra and to the Honors College for high-achieving students. Programs that provide exciting enrichment opportunities to students and community include an NEH-supported humanities center; a NASA-funded center for space research; and a forensic science program, housed in the Hertzberg-Davis Forensic Science Center.