Adding Fuel to Fire

Health insurance fuels the health system: the patient can address his or her medical needs and the health centers and hospitals can continue to meet those needs. At Health Center 6, the patient population consists predominantly of low-income individuals and a number of middle-class people. Health Center 6, along with the other numerous city and community health centers, provides high quality care to any Philadelphian, even those who do not qualify for insurance or cannot afford payments. 

But we do encourage everyone receiving such care to get health insurance, which is where I come in. As an Insurance Specialist, I screen uninsured patients to see what insurance options each individual qualifies for based on his or her income, citizenship status, and household size. Then I help the patient either apply for Medicaid (MA) or enroll in the Marketplace (i.e., the Affordable Care Act/ACA or ObamaCare).

What I’ve learned in these past four months is that the process of obtaining health insurance can be convoluted. Yes, it’s great that you can submit and track your application status online just as you would track a package on Amazon. But the reality is that most of my patients do not have someone who can advocate for them, and often lack access to the internet. In fact, most of the patients I see must wait a week or more to receive notices of welfare decisions by mail (e.g., missing/required documents, denials, acceptances), not only delaying the process, but also extending the feeling of uncertainty surrounding their ability to afford medications or treatments they need. Sometimes, a patient doesn’t receive funds for an emergency procedure because it is not deemed life-threatening enough to warrant financial aid. With federal funds, I understand that rationing is necessary. But I often wonder if medical costs could be extended more efficiently to cover emergency conditions that put at risk so many patients who walk into my office for help.

While MA benefits those within the income bracket of 100% and 138% of the federal poverty line (FPL) in Pennsylvania, the Marketplace serves as an alternative to those who don’t qualify for MA. This group includes taxpayers between 138% and 400% FPL and legally present residents who are subject to the five-year bar, which are legal immigrants who have been residing in the US for at least five years and therefore qualify to receive MA. Healthcare.gov for the Marketplace has its own completely different system. From strangely worded questions (even in Spanish) to requiring proof of documents that are buried under medical bills from five years ago, you’d think the difficult and confusing application process would deter people from applying for the ACA. Even when the whole system crashes and the patient has to reschedule his or her appointment, call off from work again, and restart the entire application with me, the people I meet are pretty resilient because their health is that important to them. However, others aren't as lucky with their subsidies. At least 17% of ACA enrollees and private insurance suscribers who make above 300% of the FPL and smokers pay steep, egregious monthly premium costs (the money has to come from somewhere!). Some of these people decide to triage their health insurance to opt for the tax penalty instead. This decision to not enroll in insurance is usually justified by thoughts such as “Is health insurance really worth it if I’m not going to use it that much anyway?” or “It doesn’t cover my needs so why should I pay for it every month for this horrendous price?” The two leading arguments against the ACA comprise rising healthcare costs for the middle- to upper-class and the tax penalty mandate for being uninsured. For 2017, the ACA just doesn’t offer enough options to some people due to the lack in competition among insurers, which is manifested in the 22% average annual increase in premiums.

MA and the ACA are fantastic for those who successfully obtain it for free or with amazing subsidies. What motivates me to come into service every day is celebrating such victories with patients. But another strong impetus is watching some patients leave with the burden of future health care costs. Hearing personal stories from patients and seeing how health insurance influence their lives make me realize how important it is for me to try my best to actively spur and smooth their decision to pursue insurance. My transition into this year of service could have been a lot more overwhelming had it not been for the patient, friendly, and inspiring nature of the people I work with, from patients to coworkers. These memorable interactions and a perspective from the inner workings of public health fuels my desire to make an impact on health care as a well-informed citizen and as an aspiring, future health care professional.

This blog post was written by NHC Philadelphia member Jenny Park.
Jenny serves as an Insurance Specialist at Philadelphia Department of Public Health-Ambulatory Health Services Health Center 6.