On an afternoon in early December, 60-year-old Columbia resident Jeannie Wyble sits in a small cubicle at Columbia’s Family Health Center, telling Aaron Swaney, a HealthCare.gov application counselor, about the heart attack she suffered in 2002.
“I quit smoking when I had my heart attack,” Wyble said. “Smoked my last cigarette on the way to the ER, never smoked another one.”
At the time, Wyble was still insured through her husband’s union plan. But after the heart attack, the insurance company began increasing her monthly premium. Wyble says at one point, she had to pay almost $500 a month.
“And then when we found out they were going to jump even more again the following January,” Wyble said. “It was very clear to us that we couldn’t pay my premiums anymore and that mine would just have to be dropped. In effect, [the insurance company] decided to get rid of me, and it worked. They did. They got rid of me.”
That was in late 2004. Since then, Wyble has relied on the Family Health Center for her primary care. She visits her primary care physician up to eight times a year. She needs specialist care. She has bad circulation on her foot, which causes cellulitis. She hasn’t been able to afford a specialist visit in nearly a decade. Her husband Austin gets nervous every time she gets sick, she said. The family could never afford a hospital stay.
Wyble has hoped the Affordable Care Act and the online health insurance marketplace could help her afford a new insurance plan. Under the new law, insurance companies aren’t allowed to charge consumers more for having such pre-existing conditions as Wyble’s heart attack. Her family income also makes her eligible for significant subsidies that can help her pay her monthly premiums. All she has to do is enroll at HealthCare.Gov.
But it hasn’t been easy. Aaron Swaney, the certified application counselor based out of the Family Health Center, first helped Wyble make an account on the marketplace on Nov. 15. By the second of week of December, her account still says “in progress.”
Swaney says most people he helps see their applications say “completed” within a day. Then, they can look at the insurance options available on HealthCare.Gov and find out exactly how much financial help they’re eligible for. Wyble hasn’t been able to do that, mere weeks before the enrollment deadline. The last day to purchase in an insurance plan offered on HealthCare.gov is Dec. 23.
Swaney thinks the problem might be the additional Social Security income Wyble gets from being the appointed caretaker of her granddaughter, Emma.
“I’ve always had weird things with children that get Social Security, that’s always, It creates a weird situation,” Swaney said.
On the heel of the website’s rollout glitches, it’s not entirely clear to Swaney how a child’s Social Security income would make Wyble’s application stuck in limbo. And there’s no guidebook on how to get it unstuck. So Swaney tries different troubleshooting techniques. Throughout multiple meetings with Wyble, Swaney has re-entered her income information in different ways. In this particular meeting, more than once, the server crashes and kicks him off HealthCare.gov.
“Have you had this much problem with anybody else’s?” Wyble wondered aloud.
Swaney thought about it for a second. He’s had similar problems with a handful other people, he said.
Wyble laughed. “Oh good. I was beginning to think it doesn’t like me or something.”
Calling the 1-800 HealthCare.gov help center isn’t much help. When Wyble’s application continued to say “in progress” after two weeks, she called the number for help, but the woman on the other side of the line didn’t help much.
“She was muddling through it and what she was saying didn’t make sense,” Wyble said. “She didn’t understand it either.”
When Swaney and Wyble called on Dec. 5, they waited for an available representative for about 10 minutes. When they finally got through, they were told to just wait more until the application fixes itself. But Swaney decided to cancel Wyble’s first marketplace account and start completely fresh. They made another appointment to see each other the next day, hoping the sixth time would be the charm.
Jeremy Milarsky, who, like Swaney, has been certified to help consumers enroll on HealthCare.gov, sums up the situation:
“This is a system that lends itself very well to people who are organized and follow up. That’s another thing that we can help people with. If you’re the kind of person who just sits back and expect everything to fall into place, you’re more likely to run into problems.”
For Wyble and Swaney, persistence was about to pay off. After six appointments and what seems like Swaney’s thousandth time pressing the “submit” button, Wyble gets the good news.
“Oh my status says ‘complete,’” Wyble said, peering over Swaney’s shoulder to his computer on Dec. 11. “Alright! Having fun now. Really didn’t think it was going to say anything but ‘in progress.’”
Now, Swaney is able to show Wyble the plans available to her and figure out what’s best for the kind of care she needs. As a federally certified and state licensed navigator, Swaney’s job isn’t to suggest a specific plan for Wyble to purchase.
“Since you use care a lot, I’m going to focus on the silver plans,” Swaney said. “Bronze plans are going to have a high deductible and gold plans are too expensive.”
The plans on the website are divided into different levels based on their actuarial value: bronze, silver, gold and platinum. Actuarial value measures the “true” value of a plan. Bronze plans, for example, have an actuarial value of 60 percent. That means on average, people who purchase bronze plans would be responsible for 40 percent of the plan's covered benefits, and the insurance companies would cover 60 percent of the cost. Silver plans have a 70 percent actuarial value, gold plans 80, and platinum plans 90. The lower the actuarial value, the cheaper the plan's monthly premium.
In the end, Wyble chose a silver Anthem Blue Cross Blue Shield plan with a $1,150 deductible and a $1,150 out-of-pocket maximum. Wyble will pay about $160 a month for the coverage. Without the Affordable Care Act subsidies, she’d have to pay about $600 a month.
“I couldn’t possibly pay that. I couldn’t pay half of that.”
She couldn’t stop thanking Swaney for his help.
“You may be making the difference between me still living in my house, six to eight years from now, you know, still having my house,” she told him. “Really. It’s that big of a deal.”
But the enrollment work doesn’t stop there. Swaney says he’s been hearing from other consumers that Anthem has a backlog of new accounts it still hasn’t been able to process yet. Wyble may have to be persistent, again, in calling Anthem and making sure she’s in their system.
Good thing Wyble’s excellent at follow-ups.
