used to be fat. (You still are, say the wags.) But I mean really fat. Shopping-at-specialist-internet-clothes-stores fat. Heckled-in-the-street fat. It wasn’t fun, but it took years before I had the willpower, the courage or some combination of the two to do anything about it.
By the time I was 24, in 2008, the feeling that I had to lose weight had been growing for some time. It is impossible to identify one event that prompted me to take action. Was it preparing to change jobs for the first time? Was it the last photo taken of me and my grandpa, which I couldn’t bear to look at? It was everything and nothing. All I knew was that my life didn’t feel worth living if I didn’t make a change.
Of course, not all fat people are unhappy or want to change, and the science around weight is very much contested. But, for me, it suddenly felt very urgent.
What I did wasn’t complicated or revolutionary. It involved years of helpful amateur “advice”, diet shows on TV and useful tips from gym-bunny friends. The idea was to eat less and exercise more – with a clear emphasis on the former.
I was incredibly disciplined about what I ate, buying healthy options and cooking in advance, and I went to the gym at least twice a week. It is not easy walking into a mirror-strewn room full of pumped-up people when you weigh more than 160kg (25 stone). But it was liberating to realise that those six-packed Adonises were far more interested in their own reflections than me huffing and puffing behind them. No matter how close you get to “the ideal body”, insecurity lurks.
l of this will be familiar to anyone who has thought about losing weight. But that is not the change that mattered the most. It was my willingness to embrace a social life that had hitherto felt onerous, but which empowered me. I knew that being home alone was when my worst habits became irresistible. So, I decided to make sure it happened as rarely as possible. I booked out every night when I wasn’t going to the gym with some social event or other. Being around people was meant to provide an insurance policy against my failure of willpower. But it was helpful in other ways that I had never imagined.
It wasn’t easy, though. All my adult life, leaving the house had been fraught with anxiety. If you have never been fat, the idea that people in passing cars might shout at you in the street simply for being chubby may seem unlikely. It isn’t. It happened to me a lot. And the excruciating embarrassment when it occurred in front of a friend was hard to bear. The forced: “Did you hear that?”, “What did he say?” brought the elephant in the room crashing into view.
Then there was the worry about where we would go. Would I fit into the seat? Would it involve a tiring walk? What if a stranger decided to take the piss? I was by no means a hermit, but I would often stay in when I couldn’t face the outside world.
But rather than terrorising me, going out became part of the solution. Nobody knew. The thought of sharing what I was doing was too scary. That soon became impossible. As the pounds fell off, people started to notice. But that was suddenly OK, because my confidence had increased, the comments occurred less often, and walking became a pleasure – it was exercise.
Relying on a social life to get through forced me to lean on friends in a way that I never had. Talking about myself gradually became easier. I was able to let people in, I was less spiky and my relationships improved. It wasn’t easy, but I don’t remember the difficulties of disciplined eating and social anxiety so much: it is the happy memories I made that have stuck.
Eighteen months later, half the weight I was before, it wasn’t just physical weight that had been lifted from my shoulders. Going out for the night was no longer scary. I didn’t need to plan any excursion to the nth degree to feel OK. Not all my worries disappeared, but a big chunk of them did – and it was a blessed relief.
“Adopt a strict diet and exercise more” is the usual advice for anyone who wants to lose weight. That can feel impossible – it did to me for a long time. But sometimes it is changing the smaller things that can help you get where you want to go. Positive change need not involve sacrifice or pain – sometimes it just means a trip to the pub with some mates.
The Big College Expense You Probably Didn’t Know About And Save For: Mandatory Health Insurance
Even though you may have solid health insurance for your family, the policy’s provisions may not meet the requirements set by the college your child attends. That means you may be forced to buy an entirely new policy the college sells or sponsors. At some colleges, the cost of the policy is over $5,000 for the 2019–2020 academic year (see the table below).
The way to avoid this charge is to get a waiver from your college by proving you have a health-insurance plan that’s comparable to the one it sells. The process to do this for the academic year often occurs in July and August or the month before the tuition bills come out.
There is a good reason for colleges’ mandatory health insurance and its stringent requirements. Colleges are understandably concerned that students could face debt from medical expenses that dwarfs even their student-loan debt. And while the cost of mandatory student health insurance is often a big surprise for many families, in some situations the college’s insurance policy can actually present both savings and a better plan. However, colleges need to improve their grade in making students and parents aware of this large mandatory additional expense.
About a month before receiving the bill for my daughter’s freshman year, I received a form email from the college stating that she was automatically enrolled in its student health-insurance plan unless I completed an online application to receive a waiver. The cost of the policy was around $1,500. This cost was not listed in the table the college posted on its website and not part of the cost data that appears in various other websites and books as an expense of attendance for the college.
I’m a financial educator focused on equity compensation (stock options, restricted stock, ESPPs) through the websitemyStockOptions.com, which even has a section on financial planning for college funding. Thus I’m financially aware and had rigorously saved for my kids’ college education, mostly in 529 Plans. This new and large cost completely shocked and baffled me.
I run a small business and already pay about $12,000 per year for a family plan. I did not see the need to pay for another health plan. While I was able to obtain the waiver and opt out of this additional expense for my daughter’s four years of college, for my son, now at another university, it’s more challenging and complex.
I soon discovered that many colleges have similar requirements. How did I fail to know about this expense? Why are colleges in the business of health insurance?
What I Learned
Your college student will receive healthcare from the student health center on campus as part of the tuition and health-services fee you pay. The health-insurance requirement kicks in for anything beyond the health services the school can provide. Health insurance that would cover emergency care for your child, which for most students would be the only reason they would need additional healthcare, may not meet the requirements the college sets.
The Affordable Care Act (“Obamacare”) allows colleges to sell health insurance and set their own higher standards based on what the school determines its students need. They can make having health insurance comparable to the plan they offer a condition of enrollment. See FAQs from the American College Health Association, other resources on its website from the Student Health Insurance/Benefits Plan Coalition, and a discussion of regulations in the United States Federal Register.
Colleges’ standards dive deep into the minutiae of insurance plans. They are very specific about the insurance features they want students at their location to have before waiving the obligation to buy their plan. In addition, under either federal or state laws, colleges cannot sell short-term or supplemental plans that simply fill the gaps where your health insurance does not meet the college’s requirements.
What It Costs
In the table below is the yearly mandatory health-insurance fee I found on websites at selected colleges, showing a wide range in this cost. Most colleges do not offer a choice of plans or alternative insurers. Plus, these costs rise yearly, even faster than tuition costs. I selected colleges from the West, Midwest, East, and South (two per region). For each region, I selected one larger university and one liberal-arts college.
Colleges Need To Improve Disclosures About This Potential Cost
Below is an example that illustrates how colleges present the requirement on their websites, yet leave the insurance cost out of the main table of college expenses. I selected from the table Northwestern University as an example of a college that does have information on its website about student health insurance in various places, but like other colleges seems to sidestep listing it clearly in a table of its costs of enrollment. (Disclosure: I’m a fellow Big Ten alum from University of Michigan, a college that does not have mandatory health insurance but does offer a student plan.)
The screenshot below is from the webpage that shows the requirement for health insurance ($4,050 in 2019–2020):
Note that while the health-service fee is listed, the mandatory cost of the student health-insurance plan is not included. It is mentioned separately as a requirement on another page. A common practice at all colleges is that this information does not appear in this type of key table of costs. It’s like leaving a critical question blank that’s worth at least 25% of the points in a final exam.
At a minimum, colleges should voluntarily at least footnote the potential cost of health insurance when they list the health-service fee and the total cost of enrollment. While I do not believe colleges are being deliberately sneaky about selling student health insurance, leaving out this cost is less than totally transparent. After all, colleges do list the cost of books, which (unlike health insurance) they can’t force students to buy; and most students find ways to lower that cost when it comes out of their own pocket (ask my kids for their savvy advice). Therefore, colleges should provide more upfront transparency about the mandatory cost of health insurance and waiver process.
Five Steps Students And Parents Need To Take
1. Once you know what college your child will be attending, be sure you check its requirements for student health insurance to determine whether you may need to pay for its student health plan. You may have time to switch into another plan to meets its standards, hopefully before the open enrollment period for the year in your current plan.
2. Look for a notice by mid-summer from the college stating that the student has been automatically enrolled in its plan, unless you opt out of it by obtaining a waiver and how to do so. This could be an email (or also a colorful postcard, which I receive for my son from Cornell University that has very specific requirements and a $3,108 fee in 2019). It may be sent via a third-party service provider/insurance broker whose website you use to submit the waiver request, such as Gallagher Student Health.
The process is a black box in some ways, unless you’re familiar with very specific provisions in your health plan. You input information about your health insurance without knowing whether or how your plan will qualify. To then receive an email that you “earned” the waiver, your plan needs to provide comparable coverage to what the college sells or sponsors.
Complete and submit the waiver application on time. Do not delay, as you may have to pay a fee for submitting it late and you may experience a backup in any later rounds should your initial waiver request be denied. Even if you do submit it on time, the college may need it earlier than the late-fee deadline. Otherwise, the charge will still appear on your tuition/bursar statement (it then gets credited back).
Alert: You will face an additional college cost unless you apply for and receive the waiver. Colleges should explicitly state this in their communications to students and parents.
3. Should your waiver request at first be denied, as it was for my son from Cornell, contact your health insurer to see whether you can get a letter documenting that your health plan meets the school’s requirements. You want to then resubmit your waiver request with this letter. Should you still be denied, your college will probably have an internal process for submitting a waiver request to someone at the college responsible for student health insurance.
If you have an HMO plan that does not have facilities in the state of your college or any limits in your plan on its out-of-area network, you are likely to face challenges in getting the waiver, as will students with an out-of-state Medicaid plan or a plan that covers only catastrophic illness. International students will almost certainly need to buy the school’s plan. (My own experience and that of others is mentioned near the end of a Boston Globe article: College-bound? The fees could end up being a big surprise.)
4. The tuition/bursar statement will have lines with many fees on it, ranging from the big tuition number to a student activity fee. Look out for a line on your tuition bill/bursar statement that seems like it could be for student health insurance (at Cornell it’s SHP Premium). Do not assume this is just another fee for the college that is part of the already extremely large sum you thought you had to pay for attending it. This is an additional fee that is potentially waivable, even if it was disclosed in a prior communication and you simply didn’t see it or receive the information.
Question your college about this fee before you pay it. I suggest that colleges put an asterisk next to this item on the bursar statement with a footnote stating that this fee is waivable and explaining the process for obtaining a waiver. That would further help prevent the unnecessary payment of this large fee when a student already has health insurance that would qualify.
5. Evaluate whether the student health-insurance plan is actually a good option to consider. For example, when you have a family plan with just one child on it, switching to a plan for a couple (or just yourself if you’re a single parent) and buying the college plan for your student can potentially reduce costs. For students who lack health insurance or have an inadequate plan, these policies offer a comprehensive choice.
As you’re scrambling to pay the upcoming semester’s tuition bill, it can be a big hassle to suddenly switch health insurers for the student, particularly if the school’s policy does not cover the doctors you now use. You would also need to change your own plan after you enrolled in it. However, if it makes financial sense and provides at least similar coverage to what you have, this is a route to at least consider. See articles from Consumer Reports and The New York Times that discuss this approach in evaluating college health insurance.
US Measles Cases Hit Highest Level Since Eradication in 2000
The United States has confirmed 695 measles cases so far this year, the highest level since the country declared it had eliminated the virus in 2000, the U.S. Centers for Disease Control and Prevention said on Wednesday.
The resurgence, which public health officials blamed in part on the spread of misinformation about the safety of vaccines, has been concentrated mainly in Washington state and New York with outbreaks that began late last year.
“The longer these outbreaks continue, the greater the chance measles will again get a sustained foothold in the United States,” the CDC warned in a statement. It said outbreaks can spread out of control in communities with lower-than-normal vaccination rates.
Although the disease was eliminated from the country in 2000, meaning the virus was no longer continually present year round, outbreaks still happen via travelers coming from countries where measles is still common, the CDC says.
As of Wednesday, the number of measles cases so far this year exceeds the 667 cases reported in all of 2014, which had been the highest annual number recorded since the elimination in 2000. The virus has been recorded in 22 states so far in 2019, the CDC said.
The virus can lead to deadly complications, but no measles deaths have been reported in the latest outbreaks. Responding to the new figures, U.S. Health Secretary Alex Azar urged greater vaccination, saying in a statement that the vaccine’s “safety has been firmly established over many years.”
“The United States is seeing a resurgence of measles, a disease that had once been effectively eliminated from our country,” he said.
Measles has been on the rise globally. More than 110,000 cases were reported in the first three months of 2019, according to the World Health Organization, based on provisional data. That is a 300 percent increase compared with the same period the previous year.
The largest outbreak has been in New York City where officials said at least 390 cases have been recorded since October, mostly among children in Orthodox Jewish communities in Brooklyn, making it the city’s worst outbreak since 1991. That total included 61 cases recorded in the last six days, of which two were pregnant women, the city’s health department said on Wednesday.
The CDC echoed city health officials in saying this outbreak was fueled by misinformation being spread about the measles, mumps and rubella (MMR) vaccine. A vocal fringe of parents opposes vaccines, believing, contrary to scientific studies, that ingredients in them can cause autism.
Nationwide, the number of children getting vaccinated has remained “high and stable” for several years, the CDC said. New York City’s Health Department took the unusual step earlier this month of issuing an emergency order requiring unvaccinated people in affected neighborhoods to get the MMR vaccine unless they could otherwise show they had immunity.
It has issued civil summonses to 12 people it said have defied the order. They will each face a fine of up to $1,000 if found to be noncompliant at a hearing.
Dr. Amesh Adalja, an infectious disease expert with the Johns Hopkins Center for Health Security, called the resurgence a “completely preventable occurrence.”
“We are fighting a disease now in 2019 that should have been off the table in the 1960s with the development of the vaccine,” he said. “It should be viewed as an embarrassment that so many Americans have turned away from vaccines that we are having a record year for measles.”
Starbucks Installs Syringe-Disposal Boxes To Protect Workers
Starbucks is expanding the installation of safety disposal boxes for used syringes to protect workers from injuries cleaning bathrooms or handling trash.
Workers at the coffee chain have reported finding blood and hypodermic needles in bathrooms, and some say they have been pricked by stray syringes, which risks exposure to bacteria, HIV and hepatitis.
The company began installing needle-disposal boxes at some locations in January and will place them everywhere employees request them, a spokesman told Bloomberg. Starbucks acknowledges the “scary situations” and its need to ensure that workers “are out of harm’s way,” the spokesman said in an email.
Starbucks has already installed the boxes in some 25 locations, according to Business Insider, including every outlet in Seattle.
Starbucks was fined $3,100 last year in Oregon following complaints from two employees who were struck with needles within a month of each other at a location in Eugene, reported Business Insider. Thousands of workers have called for Starbucks to install so-called sharps boxes in an online petition.
“At the end of the day, we want to make sure that our partners are safe,” Starbucks spokesman Reggie Borges told HuffPost earlier this year, referring to workers. “I don’t think this is a problem unique to Starbucks. I think a lot of retail business are dealing with this.”
Dr. Alysse Wurcel, an attending infectious disease physician at Tufts Medical Center, told HuffPost: “It’s sad that we have to have people injecting in bathrooms. It’s a symptom of a larger problem.”
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