Arijit Guha, a 31-year-old doctoral student at Arizona State University, hit his lifetime limit of $300,000 on his student insurance plan very quickly while fighting Stage 4 colon cancer. To pay for the remaining $118,000 in medical bills from his chemotherapy treatments, Guha started selling items on his website, Poop Strong, in February. He said a friend called his fundraiser “the world’s most important bake sale,” and he told Wonkblog’s Sarah Kliff that it “feels like this weird joke, that I’m selling T-shirts to pay for chemotherapy.”

In late July, Guha tried a faster way to address the unpaid bills: Twitter. He used the social media site to call out his insurance carrier, Aetna:

He sent a tweet to his insurance carrier, Aetna: “@Aetna’s 4th qtr profit up 73%: ‘it continued to benefit from low use of health care.’ Helps they can ensure low use.”

After he engaged in a back-and-forth with chief executive Mark Bertolini, the insurance company moved quickly to work out a solution. Within 24 hours, Guha’s 23-word tweet had done more than six straight months of fundraising ever could: It persuaded Aetna to cover all his outstanding medical bills, showcasing the power of social media to catalyze swift action from a major company. [...]

“Although he reached the limits of his plan, Aetna care managers have continued to provide support and we have worked to develop a solution,” the company said in a statement. [...]

Guha has come away with a similar conclusion. He was ecstatic about the result. But he also considers himself as an exception to the rule: Not every American struggling with medical debt gets into a Twitter exchange with a health insurance CEO and catches a lucky break.

Thanks to Obamacare, insurance providers will have to eliminate lifetime limits on health care plans. This regulation kicked in for student insurance plans in July 2012, so Guha will not have to worry about the $300,000 limit he passed long ago the next time he renews his insurance plan. And students who sign up for insurance plans through their universities will be guaranteed more comprehensive coverage.

As ThinkProgress reported in June, the plans some schools offer are mini-med plans that provide almost no protection when students actually get sick or injured. Upping the standards will lead to much better coverage for more students, and it is possible to avoid rising costs while improving benefits. In Massachusetts, for example, a number of schools joined together to buy coverage collectively for 12,000 students without dramatically increasing premiums.

According to the Government Accountability Office, 600,000 students — 7 percent of 18 to 23-year-olds in college — bought insurance through their school’s plans. By providing more comprehensive plans, like removing lifetime limits, future students faced with the same situation as Guha hopefully will not have to turn to T-shirt sales and Twitter to cover their cancer treatments.

Insurance industry sources are telling the National Journal’s Meghan McCarthy that the Department of Health and Human Services (HHS) may be “leaning” toward allowing student health plans (SHP) — health insurance policies offered to college students — to be classified as “short-term-duration” coverage, potentially exempting these policies from some of the law’s consumer protections. The news comes after various youth groups had been lobbying the agency to classify SHPs as individual health plans to ensure that the policies have to abide by the regulatory baseline created in the Affordable Care Act. McCarthy reports:

Whatever the final determination, HHS has yet another difficult decision to make on how specific consumer protections in the health care law will apply to a subset of insurance plans before exchanges start operating in 2014.

Health insurance coverage offered to students by colleges and universities arguably falls into a gray area under the health care law, especially when it comes to deciding whether certain consumer protections apply to the plans. That’s because the law, as written, applies certain consumer protections only to individual, small-group, and large-group plans.

Insurance companies and colleges argue that their student health plans do not fall within any of those categories, but are instead “short-term” coverage, a categorization that could ultimately exempt the plans from many consumer-protection regulations.

But those colleges — represented by The American Council on Education — that are lobbying for the “short-term coverage” label are insisting that their goal isn’t to exempt plans from the minimum standards. “First, colleges are not seeking either an exemption or a waiver from the law,” Terry Hartle, senior vice president of ACE and Steven Bloom, the organization’s assistant director of federal relations write in today’s Inside HigherEd. “[W]e have asked HHS to provide rules of the road on two key topics: What insurance reforms in ACA apply to student health plans?… [and] Assuming student health plans incorporate required insurance reforms and provide at least a minimum ACA-defined level of coverage, will that satisfy the individual mandate to purchase health insurance under ACA?”

Presumably, if the plans do meet the minimum standards for coverage — that is, by 2014, if a student is enrolled in a SHP she or he will meet the individual requirement — the plans will have to abide by the basic floor of coverage and will thus have to comply with at least some of the consumer protections found in the health law — regardless of their legal classification. And if that’s the case, then regulators will have to ensure that the industry cleans up some of its most egregious practices.

A recent investigation by New York Attorney General Andrew Cuomo, for instance, found that some college plans “provide woefully deficient coverage, with maximum overall caps or limits on particular types of services which can leave students with large, unreimbursed medical bills.” What’s more, the investigation found that “[m]any student plans payout far too little in claims compared to the premiums charged to the students,” exclude coverage for pre-existing conditions, and “provide no coverage at all for preventative services which college students typically need.”

Approximately 4.5 million college students nationwide receive health insurance coverage through so-called student health plans (SHP) — insurance that is available to college students — and if progressive advocates get their way, these plans will have to abide by the federal consumer protections in the Affordable Care Act, which prohibit insurers from denying coverage to individuals with pre-existing conditions, rescinding coverage, or placing annual or lifetime caps on benefits. Following an investigation by New York Attorney General Andrew Cuomo, which found that some college plans offer porous coverage that skirs state laws and regulations, youth organizations like Rock the Vote and Young Invincibles sent a letter to White House and the Department of Health and Human Services (HHS) asking regulators to ensure that SHPs abide by the regulatory baseline created in the Affordable Care Act.

The crux of the matter is whether HHS (which has regulatory authority over the plans) classifies SHPs as individual health plans — thereby requiring that they abide by the consumer protections in the law — or limited duration plans, potentially exempting them from the new federal standards. In their letter, the groups argue that the latter approach would “leave these plans virtually unregulated,” “exempt from even the most basic protections”:

Some groups have suggested defining student plans as “short-term limited duration insurance.” However, student plans do not fit into the definition of “short-term limited duration insurance.” Moreover, because this type of insurance is generally considered neither individual nor group insurance, there is a strong argument that such a definition would leave these plans virtually unregulated by the PPACA – a scenario clearly not within the intent of Congress.

Defined as “short-term limited duration insurance,” student health plans would arguably be exempt from even the most basic protections in the PPACA, including the:

- Ban on rescissions;

- Ban on discrimination based on pre-existing conditions;

- Limits on annual and lifetime benefit caps;

- Preventive care requirements;

- Minimum benefits package;

- Medical loss ratio requirements, among others. [...]

Indeed, student plans have not historically been classified as “short-term limited duration insurance,” under HIPAA, the PHSA, or any other federal statutory scheme – nor should they be. Student plans are often offered for a full 12 months. Moreover, they are almost always offered to any student who chooses to stay enrolled in a college or university. Additionally, any partial classification, leaving some shorter-term student plans regulated in this category, would merely encourage all student plan issuers to redefine their coverage as semester-based coverage, giving them a loophole through which to deprive students of important consumer protections. As such, any attempt to call student plans “short term limited-duration” plans would be both inaccurate and potentially detrimental to the well-being of several million students enrolled in them.

The American Council on Education — which represents presidents and chancellors of accredited educational institutions — and several other higher education associations disagree. They’re asking the government to “designate, in regulation, that student health coverage is considered minimum essential coverage under the individual mandate,” but argue that these plans have been traditionally seen as short-term limited duration insurance” and should be classified this way “[t]o avoid unintended consequences.”

“We believe that there is going to be coverage under ACA even under limited duration plans,” Steven Bloom, ACE’s Assistant Director of the Division of Government and Public Affairs told me in a phone interview. “The question is, tell us what they have to comply with under ACA.” The education associations do agree that the SHPs should be “made available to eligible students and their eligible dependents as defined by the policy without regard to health status or pre-existing conditions” and that they should meet the “actuarial standards of the Bronze Plan,” but do not go as far as Young Invincibles in demanding that they be required to meet almost of the requirements of individual health insurance plans.

Along with concerns that the law’s guaranteed issue and guaranteed renewability rules would undermine the plans’ student-only enrollment structure, Banson says that his group is also worried that issues like “pricing and rating” could undermine the policies. The law requires states to “establish 1 or more rating areas within that State,” but SHPs are priced differently, “based on campus population,” Banson told me.

Banson stressed that the higher education associations who signed on to the letter are not advocating against the new consumer protections. Rather they are asking for “guidance for what the rules of the road are” so “schools can understand what their student plans are required to comply with in the Affordable Care Act and what insurance reforms apply to student health plans.” Bloom says that even if these plans are “classified as limited duration plans it still means that students will have to purchase something that satisfied” the minimum benefits requirement under the law and would have to meet federal standards of coverage.

HHS is likely to issue the regulations in the coming weeks.