Affordable Care? Jersey City Residents and Government Step Into the Affordable Care Act

 ACA Counselor assists resident at the Journal Square Mobil Navigator site in Jersey City. – Photo Josh Dehonney © Harmony Media, NJ

It’s Finally Here

After three and a half years of arguing, exaggerating, praising, demonizing, promising, threatening, and attempting to repeal, the Affordable Care Act is set to take full effect in the United States of America.

Many people are ecstatic. Others are totally irate.

We are, after all, a politically polarized nation. But what about here in Jersey City? A quick look at the demographics would suggest that residents would welcome this law with open arms. Our last mayoral election was a battle between two Democrats, we’ve got more artists than Portland, Oregon (and Maine), and twenty percent of our citizens are uninsured. Certainly, if there was a place in this country that could agree to love this law and everything about it, it would be America’s Golden Door, would it not?

Apparently, no. It would not.

Reaction to the health care law has been mixed here, too. But that’s not because the citizens of Jersey City are polarized, necessarily. Many of them are just confused, and who could blame them? Ever since President Obama first brought the issue to the public in the winter of 2009, the health care bill – and then later, the law – has passed through a rhetorical house of mirrors, with each new iteration more distorted and confusing than the last.

First, it was about death panels. Then, it was about socialism. Then it was a constitutional matter – until it wasn’t anymore – at which point it was one big harbinger of our national demise

Yeah, yeah. It’s politics, you say. People take extreme positions all the time.

Right. But what’s interesting about health care is how the embellishments have affected the expectations of average citizens. In some cases, the scare tactics of one side are heard as promises to the other.

Take Frank Gutierrez, 31, who lives in the Heights. He splits a full-time schedule between two different jobs – landscaper in the mornings, waiter on weekend nights. Neither job offers health insurance, so he’s had to go without coverage for most of his adult life. When he heard about health care reform, he was excited.

“I’ve always been afraid to get sick, so I was a big fan.”

A big fan, however, of what he thought the law would be. And what was that?

“Free healthcare,” said Mr. Gutierrez.

Not subsidized healthcare, or affordable insurance. Free. Where did he get that notion?

“The news,” said Mr. Gutierrez.

Mr. Gutierrez admits, he is not the biggest news junkie. But he does listen to the radio on the way to work, scans internet headlines, and watches cable news when something big happens. And over the last three years, he’s heard so much about how President Obama was giving free healthcare to the millions of the uninsured, he assumed it was true. After all, you can’t lie on the radio, right?

So imagine his reaction when he found out early this past fall that he would soon be forced to buy health insurance or face a government penalty.

“I was confused,” Mr. Gutierrez said.

In fact, with all the talk in the media about Republicans in the House attempting to repeal Obamacare, Mr. Gutierrez wondered if they had already succeeded, and that this new mandate to buy health insurance is what took its place. Because surely, this couldn’t be the free giveaway of healthcare that he’d heard people had been raving about for years.

That’s when Mr. Gutierrez did what he admits he should’ve done from the beginning: his research. He went online and read anything he could about the Affordable Care Act and what it would mean for him.

After all, it was about to impact his wallet. After a few days, he felt fully caught up to speed. And what was his reaction then?

“Mixed,” he said. “I mean, it’ll be nice to have health insurance, but I guess I better start saving some money.”

The Affordable Care Act - Photo by Josh Dehonney © Harmony Media, NJ

The Affordable Care Act – Photo by Josh Dehonney © Harmony Media, NJ

Education is the Best Medicine

Of course, Mr. Gutierrez is not the only person having difficulty understanding the new law. Citizens from all personal, political, and professional backgrounds are struggling to separate fact from fiction, a problem that even Jersey City Mayor Steven Fulop can understand.

“From my standpoint, the biggest challenge is that it’s very confusing,” Mr. Fulop said. “It’s confusing for me and I’m probably closer to it than ninety-nine percent of people. You’ve got Medicaid, and what’s free versus where the donut holes are, all the different federal programs, state programs, local programs, where they’re intertwined, who qualifies. It’s extremely confusing.”

That’s why Fulop’s administration has made it a top priority to help Jersey City residents understand the law, what it entails, and how to take advantage of it. In October, City Hall launched the Mobile Navigator Program, in partnership with Public Health Solutions. It was funded through a $400,000 federal grant from the Department of Health and Human Services. The program opened three sites throughout Jersey City – one in Journal Square, another at The Preventative Clinic on Christopher Columbus Drive, and one more at The Bethune Center on Martin Luther King, Jr Drive (see location updates below). People can walk in, call in, or email with any questions regarding the law, the marketplace, and what it all means. Similar programs have been adopted in other cities around the state, but Jersey City is the only municipality to offer bilingual counselors, and a mobile station that will travel to different neighborhoods around the city.

Finding people capable of staffing these counseling centers wasn’t easy, however. In more abundant times, the city would have hired outside experts to come in and staff the centers, but due to budget restraints, these are not abundant times. Therefore, the Fulop administration had to fill those positions with people already employed in different departments, people who may not have known much about the health care law only a few months ago.

This presented the administration with the ironic task of having to educate those who will in turn be expected to educate the public. After all, any application counselor must be certified, which means they must first complete a twenty hour training program, then pass two separate exams that assess their knowledge of the Affordable Care Act, the insurance marketplace, and the specifics of who qualifies for what programs, local, state, and federal.

That’s a tall bar for anyone to clear, as Stacey Flanagan, Jersey City’s Director of Health and Human Services, pointed out. “There were some staff members who did not pass the examination,” she said.

Not that she blames her colleagues. Rather, she thinks it underscores the sheer complexity of the law itself, and the challenge facing local governments when it comes to implementing it.

“It’s a lot of information,” Ms. Flanagan said. “It’s really complex and understanding all of this complexity takes a long time.”

In the end, enough people from within the city government were able to pass the examination and staff the counseling centers. But that was when the real work started, as the questions began coming in.

“A good counseling session could take up to two hours because people had so many questions,” Ms. Flanagan said.

Many of the people calling in viewed the law positively and were eager to get insured but were confused by certain basic aspects – like the expectation to pay and the penalty for not signing up. Others seemed down on the law but came away pleased once they realized they had several coverage options and were not forced to buy a one-size-fits-all government plan. It was difficult to sort through all the misinformation and let people know what was actually going on, in large part because many people’s views on health care have congealed around fears and assumptions that oftentimes have little to do with the law itself.

“Some people’s misconceptions are deeply rooted based on something else that’s happening to them in their life,” Ms. Flanagan said. “It’s not about affordable care. It’s about who’s in office, or how to use the website, or their last experience at the ER. It’s a combination of so many different things. Our goal is to break down those assumptions.”

A tall task, indeed. But Ms. Flanagan is quick to point out how valuable all this work really is. “There are a lot of people in Jersey City who are uninsured. And this law will really help them.”

Will it really, though?

Alison Weil has lived in Downtown Jersey City for nearly eight years. When she’s not pulling shifts at The Odeon restaurant in lower Manhattan, she’s busy working on her budding career as a voice-over artist. Ms. Weil, 30, has not had health insurance since she was a teenager, and last year, she had a big scare.

Ms. Weil was at work one night when she first started experiencing discomfort in her abdomen. She decided it was probably just a stomach ache and would go away on its own. Over the next few days, the pain got worse, but still, she ignored it.

“No one wants to pay a thousand dollars at the emergency room just to find out nothing’s wrong with you,” said Ms. Weil.

Then one night, while at work, her condition took a turn for the worse. The pain intensified so much that she had trouble standing, and her temperature climbed to an alarming level. Co-workers had to convince her to go to the hospital, which she finally agreed to do.

It turned out she had a kidney infection, a serious illness that could be fatal if left untreated. But that’s not what had her terrified.

“I just kept thinking about my bill,” she said. “When they took my blood pressure, they noticed that my heart rate was really high, but that’s because I was panicking about how much I’d be charged,” said Ms. Weil. “Then the doctor came in and said they wanted to keep me longer for observation because they were concerned about my heart rate, which only made me worry even more. And the entire time, I have a kidney infection that could kill me, but all I’m thinking about is how high will my bill be.”

It’s an experience that everyone who has ever gone without health insurance can relate to. So that probably means Ms. Weil would welcome the new health care law with open arms, right?

Not so fast.

Ms. Weil has been a supporter of health care reform. She realizes that the health care system has serious problems regarding cost and coverage and she’s been excited about the prospects of finding affordable insurance under the new law. From everything she’d heard, the new law was really going to help her. But now that she’s learning more about the specifics – namely, price – she’s not as enthusiastic.

“I was hoping it would be a little more affordable, to be honest,” Ms. Weil said.

Ms. Weil has been comparing different plans on the new government marketplace, and has been less than impressed by the coverage that she can get for her money.

“Honestly,” she said, “I don’t think it’s worth it to pay a few hundred dollars a month when I get as sick as often as I do.”

Ms. Weil didn’t arrive at this conclusion on a whim, either. She did the math. She took all her medical expenses over the last few years (a more expensive sample than normal, considering her recent hospital stay to treat her kidney infection.) Still, however, she found that the money she spent on medical bills over the last two years was less than what she would’ve spent had she been enrolled in a silver-level health care plan through the insurance marketplace. And that points to the underlying problem that Ms. Weil and many others have with the law.

“All this law does is force me to become a customer of an insurance company,” she said. And as Ms. Weil notes, insurance companies will always leave room for profit.

Not everyone places the blame squarely on insurance companies, however. Erin Stasi, 32, of the Heights, is a homemaker with a one-year old daughter. She remembers being shocked by how much it cost for simple tests and procedures related to her pregnancy.

“The insurance companies are just covering what are very expensive procedures. But why are those things so expensive? Why does it cost a thousand dollars to turn a monitor on? I think that’s where the problem lies. But nobody’s going to fix that. They’re just going to try to make insurance a little cheaper.”

And that touches on the unexpressed fear that many people have about the Affordable Care Act. If the law doesn’t address the real drivers of health care costs, they wonder, then aren’t people simply being forced to buy into a broken system – people who may not be able to afford it?

Jersey City Health Director Stacey Flanagan appreciates the concern, but also understands that we can’t just uproot the whole system and replace it with something else entirely.

“The law is a good fit,” Ms. Flanagan said. “We have this public-private space that we need to work within, and the law does a good job of that.”

Mayor Fulop agrees. “Every program of this size will have its own problems,” he said. “But that doesn’t mean we should scrap it and do nothing.”

Getting Ready to Go

Amidst all the squabbling and confusion, it’s easy to forget that there were people who were sincerely looking forward to January 1, 2014. And not just people with serious medical conditions who need urgent attention, but people who get up for work in the morning and go about their day ignoring stomach aches and hoping they don’t slip down the stairs.

Count Frank Gutierrez among them. He’s looking forward to the first time he can go to the doctor when nothing is desperately wrong with him.

“It’s always been the middle of the night or something,” Mr. Gutierrez said. “It’ll be nice to just walk in and be told that everything’s okay.”

And isn’t that what we all want out of the Affordable Care Act? To look back and say that everything turned out okay? That despite the years of screaming pundits, broken websites, court battles and reams of misinformation, the law actually did something to improve the health care system, and maybe even our lives?

It’s all that Alison Weil wants.

“I’m just glad it’s finally here so the arguing can stop,” Ms. Weil said. “Now, if there are things wrong with the law, we can work on changing it.”

Absolutely. But let’s just hope that when the time comes to improve the law, as a city and a nation, we’ll have come to an agreement on what’s actually in it.

The Affordable Care Act - Photo by Josh Dehonney © Harmony Media, NJ

The Affordable Care Act – Photo by Josh Dehonney © Harmony Media, NJ

What is The Affordable Care Act?

The Affordable Care Act, also known as ObamaCare, is a proposal put forth by the Obama administration that attempts to address and correct a series of problems with the health care system. It was signed into law in March of 2010. The actual law includes over 1,000 pages of reforms to insurance companies and the health care industry. Some of the changes have been enacted already, such as the elimination of preexisting conditions for children under the age of 19, which happened almost immediately. Some won’t go into effect until 2020. This year, the law requires that Americans have health insurance or pay a penalty on their year-end taxes. That’s where the Marketplace comes in.

The Marketplace simplifies, for consumers, the health coverage search by collecting available options into once place (healthcare.gov) for comparable shopping based on price, benefits, and other features. Open enrollment for health insurance through the marketplace began in October of 2013 for January 1st coverage, but since there were significant problems with the website, open enrollment has been extended through the end of March.

Deadlines and Additional Information:

March 31, 2014 is the last day for open enrollment through the federal or state marketplace it is also the deadline to sign up to avoid a tax penalty. The city just announced that effective March 24 the Department of Health and Human Services will relocate several city health offices from 1 Journal Square Plaza to the new Jersey City Community Health Campus at 199 Summit Ave. Residents can go to the following locations to get help specifically to enroll in the Affordable Care Act. Since it’s the last week for enrollment, appointments are filling up so calling ahead is advised 201.547.6800.

  • Health Department Main Office at 1 Journal Sq. (M-F, 8 am to 5 pm – Until March 28, by appointment only)
  • The Preventative Clinic at 115 Christopher Columbus Dr. (M/W/F, 10 am to 2 pm & 2 pm to 4 pm – Until March 24)
  • The Bethune Center at 140 Martin Luther King Dr. (M-F, 8 am to 4 pm – Until March 24)
  • The HUB at 360 Martin Luther King Dr. (M-F, 8 am to 4 pm – Until March 31)
    Community Health Campus at 199 Summit Ave. (M-F, 8 am to 5 pm – Until March 31)

For additional information about the Affordable Care Act, visit healthcare.gov

This article appeared in the the 2014 Winter issue of JCI Magazine. © Harmony Media, NJ. All rights reserved. No part of this article may be reproduced without written permission.

Photos by Josh Dehonney © Harmony Media, NJ

Brendan Carty

the lead writer at Thinkmojo, a creative agency, and freelances for several publications. His work has appeared on CBS Interactive, ESPN, and Funny or Die, among others. He lives in Jersey City Heights with his wife and daughter.