For four years, Alisa Eanes chose textbooks over Pap smears.
As one of the thousands of UNC system students without health insurance, Eanes went without annual physicals or regular gynecological checkups.
"Do I buy my books, or do I go to the doctor?" said Eanes, a 2008 UNC-Chapel Hill graduate now working a temporary job -- without insurance -- at UNC Hospitals. "I had to buy my books."
Starting in fall 2010, public university students in North Carolina will no longer face that decision. A new health insurance policy kicks in then, mandating that all students at UNC system campuses, about 215,000 people, have health insurance. Students must either prove they have their own, or buy insurance through a new plan designed to leverage the system's buying power to offer reasonable premiums and better coverage than most campuses do now on their own.
On campuses, health officials say that with the new mandate, students will no longer have to forgo care.
"Every day there are students who walk away from lab work and prescriptions they need because they don't have money," said Jerry Barker, who directs N.C. State University's student health services. "Students have to pinch pennies. That's not good for continuity of care."
Students who receive financial aid won't incur a new up-front cost with the insurance because the premiums are factored into their aid package, but the added costs will be reflected in later student loan payments.
Campuses currently offer varying plans at varying rates. Eleven, including N.C. Central University, already require students to be insured. Five others, including UNC-Chapel Hill, N.C. State University and East Carolina University, do not, and experts estimate that 10 percent to 20 percent of students at those institutions go without coverage.
Nationwide, about 20 percent of college students are uninsured. In North Carolina, 16 percent were uninsured in 2006-2007, the most recent year for which data are available, according to the N.C. Institute of Medicine, an initiative within the Sheps Center for Health Services Research at UNC-CH. This year, that number may be higher, experts say, the result of students losing coverage as their parents have lost jobs.
Premiums rise or fall
Under the new plan, students at each school would pay $549 to $679 annually for $100,000 coverage with a $300 deductible. That means insurance costs would increase a bit for students at many campuses, but premiums would drop for students at UNC-CH, NCSU and five others, and the overall benefits package would improve, officials say.
For example, students at Elizabeth City State University now are required to pay $456 a year for health insurance, with a $6,000 maximum benefit. Under the UNC system plan, that student's premium would rise $100 to $200 a year, and the maximum benefit would rise to $100,000.
By contrast, NCSU currently does not require students to have insurance, but offers it for $1,161 annually with a $100,000 maximum benefit. So NCSU students who buy the coverage now would save about $500 a year through the UNC system plan.
One comparison: A comprehensive insurance plan a 19-year-old male could buy from Blue Cross and Blue Shield of North Carolina would cost $1,587 a year with a $2,500 deductible, according that company's Web site.
The UNC system plan's numbers are predictions gleaned from an experimental program officials conducted last fall. They could change a bit depending on actual bids from insurance companies, but aren't expected to be far different, said Bruce Mallette, the UNC system's senior associate vice president for academic and student affairs.
The potential effect of President Obama's national health care overhaul proposal isn't yet known, Mallette said.
Insured or not, all UNC system students receive some regular doctor visits on campus funded by their student fees. Still, those without are wary.
As an uninsured undergrad at NCSU, Greg Doucette went lunging for fluids at the first sign of illness.
"I definitely tried to be more observant about my health," said Doucette, now a law student at NCCU. "Every time I felt the slightest bit sick, I started guzzling orange juice. You definitely become more acutely aware."
James Daigle had knee surgery several years ago. He was insured then, but isn't now, so as he heads into his last semester at UNC-CH, he's being careful.
"I'm always cautious about what I do; I know if I injure myself, it would be a financial disaster," said Daigle, who is from Hendersonville. "If you don't have insurance, and you get sick, you don't go to the doctor because of what it will cost."
Mary Covington still thinks often about the young UNC-CH student who had appendicitis but refused surgery because she had no insurance. The appendix ruptured, and the student was hospitalized with complications, said Covington, UNC-CH's campus health services director.
Often, uninsured students who are rarely ill or injured are shocked at the costs of care. For those without coverage, surgery and follow-up care for a torn knee ligament -- not uncommon for students who like to play pickup basketball or football on the quad -- could run $45,000, Covington said.
"Medical care should be medical care, without having to factor in the financial price," she said
This new policy represents the UNC system's first attempt to standardize health insurance while using its size to get better rates than campuses could get individually.
"We're finally using our market muscle as a system," UNC President Erskine Bowles said.
But he acknowledges not all students will be pleased, particularly those whose rates will rise.
"It's a mandate and not an option, and some people won't like that," Bowles said. "On a few rare occasions, it will cost a teeny bit more. But by and large, we're able to offer far better coverage."
eric.ferreri@newsobserver .com or 919-932-2008