A Day in the Life: Helping People Stay Covered Through Economic Ups and Downs
Navigators, assisters, and certified application counselors are the unbiased people who are there helping consumers understand what the Affordable Care Act means for them and the new insurance options available to them through the law. We want to elevate their voices to share the experience of enrolling people and asked enrollment specialists to share their experiences with us in their own words. You can learn more about our work on Outreach and Enrollment here.
Here in Oklahoma, we’re a deeply red state that did not expand Medicaid, and may be facing a contracting economy due to lower energy prices. As an Oklahoma boom flips to the bust part of the cycle, it will be helpful to show how the Cap-H Health insurance Marketplace can benefit many Oklahomans, by supporting folks starting their own businesses, and allowing families to maintain affordable health coverage while providing choices of plans and providers. Although it’s unfortunate some folks also lose employer sponsored health plans with their jobs, these transitions provide an opportunity to re-introduce the Marketplace as a new, valuable way for working families affected by the economy to stay covered.
My recent talk with a consumer illustrates how in-person assistance can help overcome misperceptions about the ACA and support consumers finding a plan that meets their needs. The first week in January, Robert* visited my office. He was very well-dressed, but spoke in a very tentative voice. His sad, downcast eyes nervously looked often at the expensive watch on his wrist.
I start all of my sessions around a conference table to help put my clients at ease and ensure the appointment starts as a discussion. This helps avoid the distance of a desk or the wall of a computer monitor. As we talked at the conference table, Robert opened up and shared his story:
I want to take care of my family with health coverage, but I’ve never asked the government for help in my life. One of my two kids has juvenile diabetes, and I’ve got a heart condition, so insurance is going to be so expensive. Last month, I was an executive vice-president, but then downsizing happened. For this year, all I have is one consulting job that might pay about $50,000, so maybe I could afford insurance just for one child.
Unfortunately, I‘ve worked with many families in similar situation who have been affected by the economic downturn in Oklahoma.
I showed him the financial assistance income eligibility chart, and explained that a family of four making $50,000 may qualify for both tax credits and lower deductibles with cost-sharing reductions.
We then worked through his fears about obtaining Marketplace coverage, many of which are shared by the Oklahomans I assist daily:
I don’t like government insurance or government doctors.
“Here, in Oklahoma City, you choose from four big-name insurers and their lists of private doctors and hospitals.”
I don’t want to be taking government handouts.
“When you worked for the big company, your monthly premiums and Health Savings Account contributions came pre-tax from your paycheck, right? And the company certainly deducted the cost of employee insurance from its taxes.”
Since I’ve got a heart condition, I’ll have to buy a Gold plan. A Bronze or Silver plan only covers maybe a broken arm, not your heart.
“No. Plans at all metal levels cover the same set of benefits. The difference between Bronze, Silver, and Gold plans is your choice of the amount of cost split with the insurance company.”
I don’t want to tell the government what medicines my child is taking.
“The application only asks age, zip code and tobacco use, and does not ask about your health history.”
Why do I have to give the government my Social Security number and all my financial information?
“That’s only if you want financial help. If you wanted to apply for other types of financial help, like financial aid for college for your kids, you would also need to provide your SSN and financial information. And remember, your employer already had your SSN, plus financial and family data to give to the insurer. The discounts come to you as tax credits, so must be linked to your tax return, just like if your former company received tax credits.
When Robert had his worries addressed, then he was open to new information. When we looked into his options, the list of 51 available plans included the same insurer and same provider network as he had through the plan from his former employer.
So, I actually have more choices than from my former employer? And if I need a certain hospital because of my heart condition, I can have a different plan than my spouse and kids?
“Yes, the Marketplace offers many features and options different than a traditional employer-decided system.”
After evaluating his choices, Robert chose the same plan offered by his employer, but now, he and his family had a lower deductible, thanks to the financial assistance offered through the Marketplace. At the end of our appointment, Robert felt confident about his coverage.
This is such a relief. I want to provide for my family, and with this plan we get to keep our same doctors, but now our coverage is also affordable for our current budget. That’s probably how it should work for everyone, now that I think about it.
Before our appointment ended, Robert asked a question that lets us Navigators know a new, positive impression about ACA was created: “Is it OK if I tell friends at church about this?” I shook his hand and replied, “Yes, please do tell others. This is nothing secret, it’s just needs to be better known in Oklahoma.”
Steven Goldman, Navigator
Oklahoma Primary Care Association
*Name changed to protect privacy