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I’ve often wondered if the Affordable Care Act’s opponents have seen my reality: A youthful cousin rendered helpless by a stroke, a vigorous in-law made old by diabetes, a gregarious uncle destroyed by mental illness, and all without medical insurance.
Such struggles are not unique. Millions of uninsured Americans face serious healthcare issues, and in the past few months, many of them have begun seeking help through the Affordable Care Act.
A report released Jan. 13 by the U.S. Dept. of Health and Human Services (HHS) found that nearly 2.2 million uninsured and underinsured Americans signed up for health insurance through the federal healthcare insurance exchange between Oct. 1 and Dec. 28. Of those who signed up, 54 percent were male. Thirty percent were under 34 years old. Seventy-nine percent chose insurance plans with some financial assistance. And each one of those people, regardless of their demographic, has a story.
Linda Reid, 58, is among them.
Before 2007, Reid and her children were covered by her husband’s insurance. But when the couple divorced, Reid, a part-time unit secretary in a New Jersey hospital, was left to fend for herself.
“I still had my daughter Suzzana, who is now 17, and my son with me at home,” Reid told me in an interview. “I was able to get coverage for them through New Jersey Family Care, which is basically a program for children who don’t have any insurance.”
Unfortunately, Reid couldn’t get any state coverage for herself. And her status as a part-time non-salaried employee meant she was ineligible for a discount on her employer’s $400-a-month healthcare plan.
“Four hundred dollars was one of my paychecks,” Reid said. “There was no way I could pay for that and buy food and pay rent.”
Ironically, Reid, who worked in a hospital, could not afford to pay for medical care, so she did what the uninsured do. She muddled through, and hoped she wouldn’t get sick.
When she began working more hours at the hospital and her income increased, her children became ineligible for New Jersey Family Care. Reid decided to go to school for a social work degree. In 2008, the year she finished school, tragedy struck.
Her daughter was diagnosed with bipolar disorder 2, major depressive disorder, and schizoaffective disorder, a mental condition that causes both psychosis and mood problems.
“At that point she was covered by Medicaid,” Reid said, “but it didn’t cover all of her medications.”
Those medications included Prozac, Abilify and Risperdal. The Abilify alone cost more than $300 per month at the time, Reid said, adding another level of stress to an already taxing situation.
As Reid changed jobs and her income fluctuated, the health insurance two-step continued, with her daughter bouncing between Medicaid and the state health insurance plan.
Eventually, Reid secured her current position as a social worker for an agency that subcontracts with Philadelphia’s Department of Human Services. Last year she made just $22,000 in that position, and though she had enrolled in school to pursue a master’s degree in social work, she still didn’t have health insurance.
With a sick daughter who needed consistent coverage, and chronic health issues of her own, Reid knew things had to change, so she went to the federal health insurance marketplace. Like many who tried to use the troubled website, she had difficulty.
“I would walk around the house with my Bluetooth attached, because I knew I was going to have to hold on for hours,” she said. “A couple times I got an operator and I’d give her basic the information and then the phone would be disconnected. I would be trying to go through the website and the website was always down. One time I filled out my name and got a portion of my address in there and then it went down. It was very frustrating.”
On Christmas Eve Reid finally got through. She was visiting her parents that day, and she spent nearly six hours on the phone.
“I just kept thinking, ‘I have to cover myself and my daughter,’” Reid said. “A gentleman got on the phone and he gave me another telephone number to call and I called and somebody picked up the phone. We went through all the info, all the different plans. We went through what I could get, what I could afford, and what I couldn’t afford. I chose a dental and medical plan, and I was on the phone until almost midnight and I got an email back saying I was covered for healthcare…
“It was just so much relief… I thought my father was going to cry. They’ve been really concerned.”
But then there were more problems. After signing up and receiving confirmation, Reid was required to contact her insurer and make a payment. She was able to do so for her dental plan, which she secured through Concordia Health, but had difficulty doing so for her medical plan with Amerihealth-New Jersey.
“I just needed to go to their website, put my membership number in and pay online, and I tried to do that numerous times,” Reid told me. “It wouldn’t go through.”
Finally, after numerous calls, I got in touch with Amerihealth to inquire about Reid’s case. An hour after I reached the company, an Amerihealth representative found Reid’s number and contacted her.
“We sincerely apologize to Ms. Reid and our customers who have experienced delays in accessing AmeriHealth New Jersey portals and call centers,” spokesperson Jill Roman said in a statement. She added that extended deadlines, along with heavy call and web volume have been challenging. She encouraged customers to take advantage of the extended customer service hours listed on the company’s website.
Of course, not everyone will be willing to go through the bureaucratic maze that Reid endured, and no one should have to do so. If the Affordable Care Act is going to work, both the government and insurers will have to do a better job of walking consumers through the complicated process of enrollment and payment.
But for Reid, who has endured seven years without insurance, the bureaucracy is beside the point.
“When you have a child who’s been sick and now you can afford to get her better care, when I’ve been sick and now I can afford to choose who my doctor is going to be, choose what hospital I’m going to go to… I think the Affordable Care Act is one of the most beneficial programs our government has ever sponsored besides Social Security,” she said.