BRRRRR It’s cold in here

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People: I am wearing four layers right now. It was -15 with wind chill when I walked in at 8am and the streets are a hot (just kidding) mess. Everything has become an instantaneous ice rink, and yet our patients keep walking in. They’re getting enrolled, they’re navigating the tundra, and they look hella stylish and kind of bulky doing it, but whatever. We’re all bulky. It’s Chicago.

It’s -15 and they care enough to come and see us. I’m letting that one sink in. Who says my community doesn’t want health insurance? They care. I care. We all care. This fact is enough to warm my cold self today. I hope it makes you feel a little warm too. We’re open today when so many places in Chicago are closed, and people are here. There’s a little skip to my step today. Happy Monday.

Of headaches, tears, comradery, hope

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The last week of enrollments really were a test. My team and I had the same conversation as always– “I really want to get this person enrolled. I really hope the website will let me.” It seems like a matter of chance but in the worst peaks of the website capacity, luck was all we had. We have patients who we have followed through this process since the summer. Individuals who have seen every crash in the website, every coded flaw and have stayed persistent in their faith that they will get health insurance. They are patient, they are understanding.  These people are the reason my team was burning last week to enroll. We were running on fumes on extended hours, weekend and night appointments, so hungry to get as many as possible enrolled.  We just wanted it so badly.

Every Christmas story has a familiar frame: there’s a hard story to overcome,  a test that challenges values and strength,  and the miraculous turn that reestablishes belief and hope. My holiday season of enrollments showed this over and over again. I want to speak about this Saturday. I had appointments scheduled back to back all day  and everyone showed. As we got closer to the 12/23 deadline, no shows were rare. People were yearning for insurance and they followed through. They heard us loud and clear when we said come prepared.  They brought friends, neighbors, little ones. We quickly figured out our supplies kit should include extra chairs, kleenex, coffee,  crayons and coloring books, pens, folders, index cards. Towards the end of this first deadline in enrollment, our waiting rooms and offices felt more like small family gatherings.  We saw familiar faces, we saw new ones that entered our Primecare family. This Saturday followed was no different. I was about three appointments in when the website starting acting funny– too many people on the site, error messages, and the yellow screen of death that lets you know electronic verification is just not going to happen.

I got on the phone with the Marketplace hotline for a grand total of 3.5 hours with 3 different clients and I was surprised by the kindness of some; the absolute rudeness of some. Beatriz and I were on the phone for almost 2 hours together- the English speaking agent scoffed off my request for a Spanish speaking agent and promised a short wait time on the Spanish side. I later reasoned she sent us back to central circulation and back to the beginning of the line. Beatriz had walked in as I had already been on the line on hold for 1 hour with Pedro and his wife. I was pretty irate by the time the Marketplace got on the line with him, but almost lost my cool when they told him the website issues were due to volume and that he should try his application later. He looked at me and said, “But doesn’t she know I’m here now?” Pedro and I ended up trying two different applications before deciding we would be in touch as he made attempts over the weekend.

Beatriz and Pedro supported each other through the application process. It was way after the office had closed. They kept each other spirits up; gave each other encouraging words exchanged giggles and laughs over the horrible hotline music. Eventually, after a cup of coffee we all chirped up and things didn’t look so bad: we could all be alone trying to get through a rough patch in the application, but in the comfort of our office, we were together. We were a mismatch family. Sometimes, even health insurance enrollments needs a family of support and I’m grateful we had such beautiful company that day.

We ended up calling it quits after 2 hours on the phone for Beatriz; she was too tired, too emotionally wiped, but I couldn’t sleep. I wasn’t satisfied. I still walked home so unsure that night- how much of an impact was I making with a site that worked like that?? I continued working on her application from home (Bertha granted me status as an approved representative). Picture this: it’s 9PM Sunday night and I finally get through. We had already chatted about plans- she knew down to the T what plan she wanted. She just needed luck on her side and here it was. The exhilaration was too much and I couldn’t help myself– I picked up the phone and called her at 10PM. She answered on the first ring and said, “Oh, thank god. I wanted to call you but didn’t want to be that person.” I let her know that she was enrolled and the relief in her breath was so audible it made my heart lurch. She didn’t have words for me- and she didn’t need them. Her thank you said it all to me. She had expected me to forget; to stop trying: that’s not me. She then told me her belief in serendipty: “I met your team because I was supposed to; sometimes God places specific people your way. I needed help and you did it. I’m going to send everyone I know.” I had met Beatriz a month ago and she had suffered three appointments where the website failed and she hung on with us. Being able to enroll her and finally say “Merry Christmas” and mean, really mean it, was more than I could bear, and I’m not ashamed to say I cried like a baby that night.

Pedro tried the website countless times; he was on the phone, strongly patient and brave and could not get through. He called me on the 24th shy at the call, but I said, “Pedro, please. Shyness is for anyone else but us- you’re family.” I couldn’t get Pedro enrolled electronically. I’m finding that no amount of technology, forms, verification checks help some of our most vulnerable legal permanent residents or unbankable folks (think those with no credit or bank accounts). I was prepared to receive his fury but I was surprised to hear him steal a page from my book, “What’s the game plan here?”

I push the game plan, the what’s next, because you always need a contingency. We plan, the website laughs. Pedro and I figured out a plan and submitted a paper application immediately. I was scared he’d be upset but as we closed out the conversation on the 24th he said, “…and I can come to you with the next step?” “Heck yeah you can–you’re family.” We’re in for the long haul together.

This season of enrollments taught me so much. It is a privilege to do what we do, to hear stories, to impact lives, to get people through one of the hardest steps in recent memory. I was fortunate to see quite a number of Christmas miracles in the last few weeks to reinstate my hope. I also saw some miraculous examples of faith and understanding that remind me of the resilience of my community. These are people that have been waiting for a while and they are not going to be stopped by a website, by snow, by documents, by anything. They will be back, and we will be waiting.

Hope is a funny thing- sometimes you can see it, sometimes you can’t, but lately I can feel it all the time. We’re getting people through to the other side, a side that includes health insurance for the first time for many of them. We’re building a community and a support network in the process, and maybe that’s just my way. It’s personal. It means everything. It’s the utmost privilege and ultimately what makes every day of it worth it.

a day in the life of assistance

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It’s hard to explain a new field of work to the public: you get a lot of “what is that?” “what do you do?” “is that even a job?”Assisters are a brand new position for most institutions like mine. To add to the confusion, they can be called several things: in person counselors, certified application counselors, navigators. All of these are just super fancy names for the role of guiding the community through the terrain of the Affordable Care Act.

The job is not your typical 9-5: weekend and nights are tacitly mandatory. Unless your organizations have a lot of man power and money–PrimeCare is not in this boat– the job is not just strictly enrollment and education. Assisters are master jugglers, balancing phone calls to answer questions, appointment setting, case follow-up, one on one and family appointments, administrative paper work. If you’re my team, add the difficulty of doing this in 3 languages- English, Spanish, Polish– while having a solidly booked schedule from the moment you walk in, to the moment you leave. It’s more than a day’s work always but definitely all in a day’s work. Tuesday seems like a good day as any to show you our typical full day and the volume and richness of cases we see daily.

7:30am– walk in, immediately notice 16 missed calls on my line from when I left at 545 yesterday to this morning. Decide to complete call backs before the day gets cranking. 3 new callers and 3 new appointments interrupt my phone calls.

8:45am– my 9 am walks in early thankfully and we get going! Marketplace enrollee, only speaks Spanish. We share a cup of coffee, share some thoughts on the cold weather, and enroll her and husband in a health insurance plan for the first time in over two years when they were dropped from coverage. She calls me the little miss that could.

10 am– A team member’s marketplace appointment runs late and Irene, a 56 year old woman walks in. She’s super tiny but so fashionable in her fuchsia sweater. She’s furious after having been dropped by her health insurance two months ago and has been really lost about where to get help. She calms down after she hears she will be eligible for medicaid in Illinois, which is a vast improvement for her financially since she doesn’t work and depends on the house she rents. With the downturn in the economy, she shares some thoughtful comments on surviving in an industry where no one is renting right now. I end up giving some tough love and ask her to go get a social security card. She fights me tooth and nail but once I let her know how smoothly I want her application to go, she placates me and promises to be back this afternoon.

10:38am— My 64 year old client walks in early thankfully! It seems like a small difference, 22 minutes, but it means the world in a packed day. Altagracia enrolls in a Marketplace plan and I’m able to help her get a plan that saves her $200/ month, cuts her deductible in half to $3,000, and covers her generic medications without costs. She is ecstatic leaving the office– she had to call five other places before she found us.

11:35 am– 21 year old Beatriz walks in with her mom, Ana, who is also applying. I end up chatting with Beatriz. “I don’t need health insurance right now but my mom tells me that I need to get it,” she says. It’s smooth sailing for her application and luckily her mom is able to simultaneously enroll her and her husband in the marketplace. With the help of a teammate, mom, dad, and daughter all have coverage within an hour’s time.

11:55am– A team member comes and grabs me- the tell-tale signs of “uh-oh” are etched on her face. Esperanza is a 36 year old female. She was healthy, she was all smiles when I met her over the summer and helped her enroll. She now carries the weight of her body gingerly, slumped in a chair. Her eyes are sunken, her hands shake. She wears a vibrant head scarf to hide the effects of the brain tumor she has been diagnosed with in the last few months. She applied for CountyCare, the adult medicaid program over the summer, back when we were telling people, “expect to hear back within 75 days.” At 125 days since application date, her application represents a gross anomaly in the application turn around and she wasn’t worried about it until her medical story changed. She was fine. She was okay. She thought she would be enrolled and things change. Life happens.

She breaks down in front of me and I have to bite my cheek so I don’t cry too. I have to will myself to be strong and clear-headed for her but it’s hard. She looks too much like my mother. She tells me how since her diagnosis she has been seeing doctors wherever possible, with whomever will work with her and her friend’s finances. She begs me to help her get insured, to find out what’s going on. I end up escalating her case to our senior management team. She’s one of us now, we need to care for her until the state does on paper.

She and I chat for 20 minutes, but those 20 minutes mean the world. I promise to take on her case myself and I have. As she walks away she says, “I come back here because you and your team, you all have honest faces. You can tell that you mean what you say,” and with that she seals her place in my heart and a constant nag in my gut that promises I won’t be forgetting her all day. I don’t. “Thank you for helping me. I don’t have anything to pay you with and I can’t promise you that I will ever be able to pay it back, but I know that God will.”

12:15pm– I get a call from the Emergency Room at Saint Mary and Elizabeth Medical Hospital- there’s a woman in need of assistance. I take a brisk walk over and see her. Carmelita is 59 and she has the kindest eyes and smile I have seen in a long time. She lost her job a few months ago and is now living in a shelter in a church. She is uninsured and really worried about the pain in her back. I get her enrolled in CountyCare and she and I dedicate a good amount of time to the game plan as I call it. She has no reliable cell: “They give a phone but I use up the minutes so quickly since there are such few minutes.” We agree that I will be in touch with a sister at the church and make a plan to meet if she should receive any communications. She also asks me to become her approved representative so I can also receive her correspondence. I wholeheartedly agree. As she leaves she says, “Thank you for being nice and not making me feel bad. No one is ever nice to people like me.”

1 pm-– An ED attendant spots me as I’m getting ready to leave and asks me to see someone. Josselyn is taking care of her mom who just got admitted into the ED. She had applied for CountyCare over the phone over the summer at the central office but her application was inexplicably incomplete. Her mom has now been admitted and definitely needs insurance. I start to ask Josselyn her mom’s information and she stops me– “I’ve been up all night. My brain is fried.” I stop her and say, “It’s okay. Go home, rest, and if you think about it, grab your mother’s state id, social security card, and utility bill. I’ll come see you here at the hospital whenever you’re ready.” Updated note: Josselyn called me the next day and asked me to come to their hospital bedside, and I did. Mother is now enrolled in CountyCare and her emergency room visit and stay will be covered.

2 pm– I finally make it back to the office. Team mate grabs me– rumor around hospital is there is a free holiday lunch!

2:35pm— 19 missed calls. Get back to calling everyone back. Too many scheduled appointments and answered questions it all starts to blur.

3:30pm— I get on the path of starting to figure out what’s going on with Esperanza’s case- I’m on hold for 45 minutes and don’t hear anything new.

4:15pm— CountyCare policy changes get announced- I get on the line with administrators at CountyCare and try to get on the investigative trail of some applications I’m worried about.

4:55 pm—  I chat with senior leadership about Esperanza’s case and get advice on next steps.

5:05pm— I call Esperanza and talk next steps. She’ll be in to see me later on in the week to chat about her care.

5:10pm– I call Irene and leave a calm nice message but really I’m thinking: “Ireennne– where are you???”

5:25pm– Team powow/ decompression minutes- we chat the world, Ke$ha, and the cases that are under our skin.

5:33pm— Irene walks in with Social Security card print out in tow– Thank heavens.

5:48pm— I finish this morning’s cup of coffee.

These are a few of my favorite things…

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There are two main ways individuals can enroll in programs here in Chicago: state medicaid programs and the Health Insurance Marketplace, the federal portal for private health insurance with financial assistance for some.

The Marketplace has a mandatory account creation step if you want to complete your application electronically. Realistically, if you want a chance at real time results and verification, this is the way. You could try your hand at a phone application or mailing in one, but every indication tells us wait time lasts several months. That’s time most of my patients don’t have to spend. There is no guarantee that they will be able to come back or want to. When daily survival and life bogs you down, your health insurance becomes the last thing you worry about

I have become a creature of opportunity- I have to jump on every chance I have to complete an application in one sitting whenever possible because I have learned the lesson the hard way… people whose stories break your heart, stories that stay with you when the dissatisfaction of an incomplete application strikes, and the step after: the cold and heartbreak when you never see them again and you don’t know what happened. I have come to resent account creation. It reminds of me daily of the privileges my clients don’t have: emails, regular computer access, literacy.

The aspect I want to chat about for a second are the security questions. I know I personally don’t mull them over a lot, its heartening and cool to see our clients insert their personalities and selves through their responses. These questions are things like: What’s your favorite childhood toy? Who is your favorite childhood friend? Where’s your favorite vacation spot? Sometimes, these questions in account creation give us a break from the serious and monotony of the application:

 G: What is your favorite cuisine?

I:  Tamales

G: Really? me too.

I: I really, really love them but don’t tell my husband– I ate his this morning and blamed it on my son.      He’s still really grouchy.

G: Secret is safe with me 😉

Sometimes, these questions break my heart. Today I asked Ignacia what I thought to be an innocuous question. We were on a roll- we had just shared a moment. We had an inside joke now. We’re laughing. Lets keep laughing, right? Wrong.

G: What is your favorite childhood toy?

I: [Silence. Ignacias demeanor changes, she slumps down, smile is gone. My heart sinks]

G: Ignacia?

I: I’m not ignoring you, I just… I haven’t had to relive those times in long time. I grew up poor, the poorest of the poor. I had no toys. I had my dog and my sticks.

G: I’m sorry for the question, Ignacia. I can select another question if you would like.

I: No, it’s okay miss. I’m not ashamed of my past. Besides, isn’t the whole point of security questions to pick something I will never forget?

Ignacia was able to choose her answer and we moved on in the application. I’m still playing the waiting game with her, but at least we have each other as friends and allies to help get her through this process. This is one answer I will never forget.

Beginnings

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The structure of the first post of all nascent blogs looks the same to me. We’re talking about that I really hope you like me post- some post that states “wahhh, I don’t really know the identity of my blog, but I’m going to write anyway and hope that you find me interesting.” Creativity stroke on the train today at 9PM: the stories I want to tell, the stories that I feel compelled to share and tell are interesting and need a home beyond the confines of my mental space. I hope some of you will stick around to hear some of them.

I work as an Outreach and Enrollment specialist in Chicago, IL. For weeks now, I have watched my friends and family physically glaze over as I try to explain the universe of what that means to me. It seemed like a good time as any to give it a go a few days when I was in my second home of Grinnell, Iowa and still found myself lost for words six months into the job.  There is no elevator speech, no canned words, just an immense rawness.

I found myself starting by describing my day-to-day functions mechanically: I help enroll people and educate them in the Affordable Care Act, “ObamaCare”. I push applications through all day to help people gain health insurance. People usually went “oh, that’s nice.”

As I walked away every time, I felt incomplete, uncomfortable, but mostly just inaccurate. How do you capture human impact in a neat description? I’ve wrestled with that question for a week now, and this blog seems like a small step in figuring that out. What I do know is that any combination of words I string together feels wrong without telling the stories of Ann, Pedro, or any of the lives my team has touched this year.

What do I really do all day? I listen to people’s life stories as they bare down heart, soul, bank accounts, family life, to grant me a sneak peak into their eligibility to state and federal healthcare programs.

I see tears, laughs, raw moments, new learning moments, human nature, manipulations, deceits, anger, pain beyond measure, emotional scars. I see confusion at a new system change; I see wonder and joy at new health opportunities; I see frustration; I see apathy. In the short of it, I see human nature at its finest and frailest.

Enrollment assistance is what I do, but it comes with so much more than I bargained for. These are the stories of some of these I’m fortunate to work with. Names and substantial details will always be changed to protect the identities of those I have been privileged to assist. I’m not really looking for kudos here. I don’t really know what shape this blog will take, but it really isn’t about me. It’s about the lives we touch, the stories we hear.  These are the faces of the Affordable Care Act–the real ones– and they deserve a chance to be heard.