Yale: Inclusive Health Care for ALL Students

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📅 November 21, 2024 ✍️ By Daniel Aguirre ⏱️ 11 Mins Read 🗂️ Blog 🕒 Last updated: November 22, 2024 📌 Tags:Yale Law School

Today — Jan. 22, 2023 — marks the 50-year anniversary of Roe v. Wade, the landmark Supreme Court ruling that conferred the national right to an abortion. At the time, nearly all states enacted total or near-total abortion bans. But in 1973, the Supreme Court decreed such bans unconstitutional, making abortion safer and more accessible for pregnant people throughout the country.

While Roe’s legal implications were enormous, even Roe could not make access a reality for everyone, and low-income people, people of color, young people, and others continued to face obstacles to abortion care. But six months ago, in June of 2022, the Court took sweeping steps against human rights and revoked this right. Now, we see active total or near-total bans in 14 states and blocked bans in 8.

People across the nation and the world rallied in response to June's Dobbs decision — including at Yale. Students and alumni took to protest last spring and summer. And in October, over 200 Yalies gathered on Cross Campus to kick off a campaign to demand that Yale University provide inclusive reproductive and gender-affirming health care to all its students, as well as take steps to better support the New Haven community.

The newly-formed Inclusive Health Advocacy Coalition — a university-wide group of students from Yale College as well as Yale's graduate and professional students — brings forward this open letter to Yale administration on the 50th anniversary of Roe. We welcome individual and group signatures alike, spanning across students, faculty, alumni, New Haven community members, and other Yale affiliates, and hope to soon engage with members of the Yale administration and Board of Trustees on next steps.

The Yale University endowment currently sits at over $41 billion, yet many of its students and members of the New Haven community at large go every day without access to critical health care, including contraception, abortion, gender-affirming care, and mental health care. While Yale offers its students a basic plan at no charge, prescriptions, obstetrics, and emergency services fall under “specialty coverage.” This specialty plan costs over $2,700 a year per student and does not include dental and vision care. This means that the free basic plan does not cover all birth control options, hormone replacement therapy (HRT), pre-exposure prophylaxis (PrEP), post-exposure prophylaxis (PEP), or medication abortion. Students are also referred to outside providers for abortions, even for medication abortions, despite evidence demonstrating that medication abortions are incredibly safe and effective when self-managed outside of a clinical setting.

Additionally, Yale’s LGBTQ+ students face incredible obstacles to accessing health services like HRT, PrEP, and PEP. Yale’s excessive wait times for service requests and its up-front cost model for HRT limit care to only those with significant resources, time, and support. This issue of excessive wait times is also true for mental health services at Yale, along with a need for more LGBTQ+ and LQBTQ+-trained mental health care providers.

These are pressing issues that must be addressed NOW. With abortion bans, anti-trans bills, and other dangerous restrictions on the rise across the United States, many Yale students are threatened by oppressive legislation in their home states. Furthermore, in light of Yale's recently professed commitments to student mental health, reproductive healthcare reforms become even more urgent. Access to contraception, abortion, and gender transition services are integral to mental health. As such, Yale has an opportunity to be a leader in providing its students with truly comprehensive, quality, and affordable care at an unprecedented time in Yale’s and the nation’s history. Yale must step forward to provide equitable, inclusive care for all students now.

Our demands for Yale are as follows:

Expand access to care at the Yale Health Center Pharmacy for all students, including those without Hospitalization/Specialty Care Coverage, to:

Provide free abortion pills. Abortion pills, also known as medication abortion, are incredibly safe and effective in the first 10 weeks of pregnancy. Access to medication abortion pills is a time-sensitive service, and a referral process can lead to a delay in care and an increase in cost if the student finds they are outside the 10-week mark and must, therefore, receive a procedural abortion. Several of Yale’s peer institutions have already instituted this policy. In response to student advocacy, Barnard University recently announced that it will make abortion pills available to its student body, and required dispensing of medication abortion has been codified into state law for public colleges and universities in California and Massachusetts.
Provide free pregnancy tests. Students can access pregnancy tests at the Yale Women’s Center, but variable hours and limited swipe access mean that not all students are able to access pregnancy tests easily and affordably.
Provide free PEP. PEP is a course of medication taken after a possible exposure to HIV and must be taken within three days of the possible exposure. Because this is a time-sensitive service that students on the Yale Basic plan cannot easily access on campus, they must go elsewhere for this course of medication, adding unnecessary care delays and endangering health.

Expand coverage under the Yale Basic Plan to:

Cover ALL contraceptive options. Generic forms of oral contraceptives are included under the Yale Specialty prescription coverage. These ought to also be covered under Yale Basic so that all students can access birth control. But current oral contraceptive options — all of which are hormonal — are neither safe nor suitable for all students, as various medical conditions and medications can preclude their use. Several students who may need non-oral or non-hormonal contraceptives, such as the NuvaRing or copper intrauterine device (IUD), have shared that high co-pays are a barrier to receiving care on Yale Basic.
Cover abortion (not just referrals) and improve communication to students about abortion access on campus. Yale’s policy on abortion coverage is extremely difficult to navigate. Students, administrators, and Yale providers alike are not clear on what Yale covers. While Yale Basic covers abortion referrals, the abortion itself is not covered. Many students relying on outside insurance coverage, often through their parents, typically do not have plans that cover abortion, and out-of-pocket costs for abortion procedures at Planned Parenthood range from $600-800 on average.
Cover hormone replacement therapy (HRT). HRT is a medical necessity for many trans people, especially those with gender dysphoria. HRT is expensive (prescriptions cost up to thousands a year) and is currently gated behind Yale Specialty, which raises cost and privacy concerns for many students. Seeking HRT on Yale Specialty can out trans students to their parents. Covering HRT under Yale Basic would allow students to receive HRT privately without cost.
Cover PrEP. PrEP is a course of medication prescribed to prevent HIV. PrEP is expensive (prescriptions cost up to tens of thousands a year) and is currently gated behind Yale Specialty, which raises similar cost and privacy concerns. Covering PrEP under Yale Basic would allow students to receive PrEP privately without cost.

Improve the current system to receive gender-affirming/LGBTQ+ health care as follows:

Guarantee a maximum wait time of four months for HRT requests through Yale Health.
End the counselor letter model for HRT and move to an informed consent model. The current model for HRT access requires students to see a mental health counselor to get approval to begin receiving care. This is not the standard practice. The World Professional Association for Transgender Health (WPATH)’s most recent Standards of Care identifies the informed consent model as the standard for gender-affirming healthcare access for adults. Leading healthcare providers, such as Planned Parenthood, utilize an informed consent model. Meanwhile, Yale lags behind, forcing students to seek approval from counselors — the overwhelming majority of whom are not LGBTQ+ or sufficiently practiced in gender-affirming care — through the already overloaded Mental Health & Counseling system. This creates a double burden on trans students seeking care.
End the reimbursement model for gender-affirming care and move to upfront coverage for all. Currently, students seeking gender-affirming care must pay for their healthcare costs out-of-pocket and submit for reimbursement afterward. With costs for electrolysis hair removal averaging $80 an hour, for example, many students can not afford to cover these costs upfront. This system places a massive financial barrier in front of students seeking potentially life-saving gender-affirming care at Yale.

Create a more accessible and inclusive mental health and counseling system as follows:

Reduce wait times to a maximum of two weeks. This is self-explanatory. Yale students have long demanded shorter wait times at Yale Mental Health & Counseling — and reproductive and gender-related health services are critically tied to mental well-being.
Hire more LGBTQ+ and LQBTQ+-trained counselors/therapists. There are few openly out queer counselors, and still fewer openly out transgender counselors. LGBTQ+ students disproportionately face mental health issues, and the lack of competent care compounds this problem.

Support the New Haven health care providers and organizations who support Yale students in addition to the broader New Haven community as follows:

Donate to New Haven reproductive health clinics and LGBTQ+ organizations. Yale has an ethical obligation to support off-campus reproductive care providers that serve Yale students and New Haven communities, especially given increased care delivery pressures in Connecticut associated with the COVID-19 pandemic and post-Roe state-level restrictions. We recognize that as members of the Yale community, the resources we have access to are oftentimes vastly different from those of the broader New Haven community. Abortion bans and anti-LGBTQ+ legislation affects us all, but it affects the working class the most. We call on Yale to donate to abortion providers — such as Planned Parenthood of Southern New England, Cornell Scott Hill Health Center, and Fair Haven Community Health Center — as well as to funding entities like the REACH Fund of Connecticut and Indigenous Women Rising (which, though based in New Mexico, works to support all Native and Indigenous people in Canada and the United States, including in Connecticut, seeking an abortion in the United States). This demand is readily achievable. Yale already facilitates the Yale Community for New Haven fund, which can and should be expanded to meet the reproductive and gender-affirming health needs of the wider New Haven community.

Reproductive and gender-affirming healthcare are human rights, and Yale has both the resources and the obligation to help make this a lived reality in New Haven. We appreciate your attention to these deeply pressing matters, and we hope Yale will step up as a national and global leader in this domain. Representatives of IHAC, as well as of campus-based student elected bodies, look forward to engaging with members of the Yale administration on swift and concrete next steps to respond to these exigent circumstances.