By Rose Hoban
During the last week before Gov. Roy Cooper ordered the closure of restaurants and bars to all but takeout service in March, Stephen Murtaugh could read the handwriting on the wall.
At Carrboro’s Oakleaf restaurant, where he was manager, Murtaugh said they were cleaning and disinfecting, attempting to reassure customers they’d be safe to come in. But the diners just didn’t show.
“Going into that weekend, Friday the 13th, Saturday, the 14th, it’s like, well, maybe we’ll get them back this weekend,” he said. “The restaurant industry has got so many ups and downs anyway, but when that weekend came, and [customers] really didn’t materialize, that’s sort of when it just felt like the bottom kind of just dropped right out.”
A few days later, Murtaugh’s boss laid everyone off.
Few independent restaurants make enough to insure workers. Instead, Murtaugh bought his health insurance on the Affordable Care Act marketplace every year, where he was able to get a small subsidy of about $30 on a plan that cost him about $450/ month. He described the plan as “some crappy thing in case I get run over by a truck basically,” but he was determined to keep it despite losing his income.
He’s not alone. Across North Carolina, hundreds of thousands of people have lost their jobs, and for many of them, their insurance along with it. But there are some options.
Confusing options
Medicaid may end up covering some of the children of these newly unemployed if their family income drops to below 200 percent of the federal poverty level ($42,660 for a family of three). Medicaid is a counter-cyclical program, meaning that even as the state has reduced tax revenues to pay for the program, more people will need benefits.
It’s close to impossible for an adult in North Carolina to qualify for the program unless their income is below $6,245 and/or they have a permanent disability.
One low-income option for coverage, Medicaid expansion, would cover people earning up to 135 percent of the federal poverty rate ($29,973 for a family of three), but that option has been staunchly resisted by the General Assembly, making North Carolina one of only 14 states without this option for the newly unemployed.
“In a crisis like this, not having insurance is a serious problem for people. So it should, in my mind, raise the conversation to a level where people are much more willing to do that,” said Dave Richard, the state’s Medicaid head. “Having an insurance product that covers that many more folks in North Carolina would obviously help that.
“Frankly, this is not going to be something that the impact is, you know, miraculously ended.”
Beatriz Plaza at first hoped she might be able to get Medicaid but realized that would not be possible. She initially panicked when she was laid off of her job as a public health consultant on April 3. She’s in her late 50s and has a couple of preexisting conditions, so she needed to move fast to get herself some coverage.
Plaza got onto the government’s Healthcare.gov website to sign up, but she soon got lost in the weeds.
Then she got lucky, picked up the phone and got an operator who walked her through signing up to get a plan that will keep her with her doctor.
“That’s me, okay, me who has access to a computer, me who has half a brain to figure things out? Me, I’m a public health person, that’s my background,” Plaza said. “So had it not been for this person on the other side at the exchange to walk me through it, and have the patience and the time… I just find it very difficult to believe how people can actually get in there and actually get what they need.
“It’s not intuitive.”
But Mark Van Arnam said you don’t have to rely on being lucky enough to get an operator at Healthcare.gov, all you have to do is call his organization.
Help available
Van Arnam runs the North Carolina Navigator Network, a group of both paid and volunteer advisors who can help steer people through the sign-up process.
“There are folks that are confused and thinking that they’re not eligible,” he said. “Or they’re finding extremely long wait times when they call Healthcare.gov. I talked to somebody the other day that told me that they were on hold for two and a half hours before they could get to somebody, and then that person was not able to help them.”
Luckily that person was able to get with one of Van Arnam’s navigators who was able to sign them up through the website.
“Let’s face it, insurance isn’t easy for anybody,” Van Arnam said. “I’ve been doing this since 2013. And sometimes I still get stumped.”
He said it takes several cycles of the open enrollment period for the navigators to really know their way around, so he’s not surprised beginners on the website get lost.
The navigators helped Stephen Murtaugh adjust his plan. He went from paying more than $400 a month to having subsidies cover his entire monthly premium.
“Having somebody that has experience on the phone with you, I think is a pretty cool thing,” he said.
Changed mind
That’s also what happened for Ian Phillips, who lost his job as a restaurant manager in Wilmington after 21 years at the same place when the restaurant chain decided to close the branch.
“I’ve been with this company since I was 22, and I’ll be 43 this year,” he said.
Phillips said insurance was nothing he ever had to worry about, and before now, he was skeptical of the Affordable Care Act.
“I’ve never had, you know, a pony in the proverbial race of health insurance,” he said. “I’d never really heard a lot of great publicity about it.”
After an initial experience on the website, he Googled around and ended up on the phone with the Navigator Network.
“An hour and a half later I was signed up good to go, we qualified for some credit, so the insurance was extremely affordable to the point where even being on unemployment I’m not really paying out of pocket,” Phillips said. “That was a blessing in disguise.”
The biggest surprise? The cost.
“It was hard for me to believe coming out of, you know, prior coverage where I’ve been paying, two, three, four hundred bucks a month, with my employer adding to that,” he said. “Once I realized how easy it was, I called both my salaried managers that worked under me and had them sign up.”
According to Van Arnam, the navigator network has had a 300 percent jump in calls in March and April.
They also got a lot of calls from people who missed the open enrollment in the fall, who wanted to get onto insurance now. But he said they couldn’t help them because the federal government decided against reopening the insurance marketplace when the crisis hit.
Many people called because they thought they fell into the gap in coverage created when North Carolina refused to expand Medicaid to cover all of the people making less than 135 percent of the federal poverty rate (less than $29,322 for a family of three). But for many, Van Arnam said they’re not estimating their 2020 total income correctly.
“A lot of folks don’t really think about their unemployment benefits as income. A lot of people don’t think about that added federal unemployment benefit that’s happening now as income,” he said. Those, plus year-to-date income, often puts people over the line where they can qualify for an insurance subsidy.
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Your article on how unemployed can get health insurance vividly illustrates why this country has such a problem getting affordable health care for all. Many people who get insurance through their employers-an anachronistic vestige from long ago-have no idea what they actually pay. Their paystubs are on-line now and most people don’t look at them regularly. Their employer pays more than half the cost, which is money they could be getting in increased pay. But so many people are so blissfully ignorant about the true cost of that insurance they are all “so happy with”, they do not understand how much better off everyone would be with a system that included everyone-the healthy as well as the sick-to lower costs for all, which is what the individual mandate attempted to do. A single payer system would reduce inefficiencies enormously and be available regardless of changing life circumstances. That payer should also be the federal government. No one working for them makes millions of dollars a year in salary, like private companies. It should not be states either because why does someone in Mass deserve better health care than someone in North Carolina, which is the case now?