Health Insurance

       I've been in a six-month battle. At times it has been hard fought. At other times I don't realize it is going on. What I'm talking about is health insurance. Growing up I knew having health insurance was important. I knew that it was something my parents took care of, but like any kid, I had no idea what it was, how to get it, or how much it cost. I think I naively assumed it was something everyone had, but I also never understood how it fundamentally worked. Abstractly I knew that it helped pay the costs for medical care. Terms like co-pay, deductibles, and network coverage meant very little to me at that age. I  was pretty lucky growing up. I never broke a bone, never needed serious medical attention for anything, and other than being a little pudgy with a mouthful of hardware, I was a pretty healthy kid. Part of me thinks that luck played a major role in my lack of emergency medical care. Looking back at it now I sort of feel like it was building up to something dramatic. Sure enough that moment came when I turned 18 and I tore my ACL playing basketball.

       The injury was pretty text book in that I fell at an awkward angle jumping up to steal a pass and twisted me knee in a way it was not supposed to twist. After getting an MRI a few days after the swelling went down, I was told that I would need to have surgery. From my perspective, the operation and subsequent 6-months of therapy were all taken care of by my parents through the insurance we had. Little did I know that getting approval for the operation was more of a battle for my mother then I realized at the time. I never thought it would be complicated to make sure the insurance company would pay for the procedure? I didn't realize that we had to contribute a portion just to be eligible to have the rest paid for. Being 18, I didn't think about how complicated health insurance claims could be because my family took care of everything, and told me to focus on rehabilitation so I could head off to college in the fall.

       Three years later as I was applying for the Peace Corps I was told that I'd need to have my wisdom teeth pulled. This time we had to pay a higher percentage of the bill to do the procedure because the operation was technically "elective." When I graduated from college I was placed in the Peace Corps insurance system, which pays for everything from major operations to bug spray without asking second questions. As I was wrapping up my service, however, I started to think more and more about my personal need to get my own insurance plan for when my service was completed. The Affordable Health Care Act had been passed, and the timeline to enroll in the marketplace coincided with when I was completing my service. I was aware that Peace Corps offered volunteers a an relatively expensive but extensive insurance policy for up to 18 months after service. With the passing of the Affordable Health Care Act, however, that policy had been cut to only cover a maximum of four months. After hearing that news I started looking into my health care options through the healthcare.gov website at the end of October 2013.

       When I was in Paraguay, I did read about current events in the states, but when I started hearing about the problems with the healthcare rollout I didn't really understanding what was happening. I was in the middle of winding down my service and was focused on planning a trip for after I was finished. I never thought that this modern looking website wouldn't work. The thought never even crossed my mind. I then came across a blog post that furthered culled my concern about getting health insurance through the Affordable Health Care Act that pertained specifically to RPCVs: (http://mapya.wordpress.com/2013/10/03/why-obamacare-is-fantastic-albeit-confusing-for-peace-corps-volunteers/). The information was very enlightening, and convinced me that I wouldn't have a problem getting covered when I got home. I even applied through the market place while in Paraguay. I found the website to be pretty straightforward, but struggled to answer some of the questions. In particular, I couldn't seem to accurately describe my financial situation as a Peace Corps Volunteer on the website.

       When asked to provide my income I was befuddled. In the Peace Corps we make roughly $3,500 dollars annually that is put aside to given to us at the end of our service, and another roughly $3,500 to live off of annually in country. These numbers are approximations, but basically for 2013 I would make about $7,200 plus about $1,000 from personal investments. That number if adding it all together is about $8,200. According to US Census Bureau the poverty threshold for a single person in America in 2012 was $11,720 (http://www.irp.wisc.edu/faqs/faq1.htm). From a strictly monetary perspective, I lived below the poverty line based on my income. The problem was that I was not in poverty at all. My living situation in Paraguay was comfortable. I had some savings, on top of that I didn't have a credit card bill, wasn't paying off loans, didn't a car back, didn't have car insurance, my health care coverage was free, and I wasn't supporting a family. The questions on the application for Health Care totally bewildered me. I  answered them as best I could, but  couldn't get a response about my eligibility.

     When I left Paraguay at the end of November, I had health insurance through the after Peace Corps health plan. I could could extend the coverage through March 25, 2014. Given my lack of understanding about the problems with the Health Care role out, I figured I would wait it out until I got back to the States. I kept hearing that the system didn't work, and decided not to press my luck at that time.

       When I did eventually arrive back home I reapplied to on healthcare.gov. I was still running across the same problems I had with answering the questions about my income. I knew that the White House was pushing enrollment, especially for young people. Before I continue I think it is important to mention that I am a 25-year old man that currently (knock on wood) has no serious medical conditions. I like to think I live a healthy lifestyle, and I truly wanted to get on a health plan through healthcare.gov. I think I applied in early January after being home for a few weeks. After completing my application I given a generic 11 page pdf that said I "May be eligible for Ohio Medicaid." I kept thinking Medicaid? Isn't that for disabled people? I quickly realized that it was more for low income people, and seeing that my answers to the questions about my income put me into that category. I had no idea what to do? After not hearing anything for a month I called the phone number on healthcare.gov. The people on the phone were very nice. I explained my situation to them, which went to go something like this:

Me: "I recently returned from serving in the Peace Corps, and my income is low as a result of just having returned and being in the process of procuring employment. I plan to find work in the next few months, but I have no idea what that will look like. I can afford a basic health plan, but keep getting told that I should apply for Ohio Medicaid?" What should I do?"

Person on the phone: "Well hmmmmm. As you know there have been a lot of problems with the website. Where did you say you were from?"

Me: "I currently live in Ohio, but that is subject to change"

Person on the phone: "Well I will take down your information and resubmit your application"

Me: "I've already waited a month, and heard nothing? Can you think of another option"

Person on the phone: "You could reapply? What county do you live in?"

Me: "Hamilton County"

Person on the phone: "Lets see where you can go in your area. You could try the Cincinnati Health Department?"

Me: "What are they going to tell me?"

Person on the phone: "Honestly, they would just have more information."

Me: "Can you think of anywhere else I can go?"

Person on the phone: " I actually live in Florida. I'm Sorry I cannot be of more assistance."

Needless to say this information wasn't helpful. I reapplied, and got the same message about applying for Medicaid again before I called the phone number again. This time I got some more information. According to the guy on the phone, none of the roughly 700,000 applications filed from the healthcare.gov website had been submitted to the Ohio Department of Health. I had absolutely no idea what that meant? From the way it sounded nobody in the state could use the website get affordable health care. My situation was an outlier. There was not protocol for me within the system. On top of all that the clock was ticking on my health care options. A huge reason why I wanted my own plan was that I be turning 26 in June. I figured it would be better to get a plan well in advance so I'm not scrambling come June. Now I was hearing that I needed to fill out the exact same application that I had completed four times on the Ohio Department of Health website, which was a much crappier version of the Federal website. The questions were almost exactly the same, but the interface looked like something from the late 1990s. The guy who told me I should do it this way asked me where I lived . I said Cincinnati. He said that the speed of a reply depends on the population of your county. I said, "well Hamilton County is one of the biggest in the state." He said, "yeah it might take a month to hear back."

       I was totally fed up. I couldn't believe that a healthy, young, supporter of the the whole concept of universal health care was unable to figure out how to get a reasonable plan that I could afford without going on Medicaid. I was furious, so I decided to try to get private insurance. That process was more complicated, more expensive, and more limiting based on networks and geographic regions. I had several conversations with private insurers who weren't really helping me out. Eventually desperation came into play. My insurance was running out, and I had to jump onto my mother's plan so I had some kind of coverage come March 25th. In that time I lucked out. I got a job that offered a health plan. I jumped on my mother's insurance for a week before I moved to Washington, and was able to enroll in an employee health plan. Story over? Hell no.

       A week after I started my job I got a phone call from my mom telling me that I got two letters from The Ohio Office of Medicaid informing me that I would receive a Medicaid card in the coming weeks. I never received, an email, a phone call, or any other information before I was enrolled in the program. I  now have to cancel this for obvious reasons. What I've learned since, is that Ohio's government expanded aspects of the Affordable Health Care act for the poor, which is great. It did not embrace all aspects of the law. My State's leadership sort of froze me out, and it honestly really bothers me that I couldn't figure out how I could get into the system. 

       I have been trying to resolve this conundrum since before I left Paraguay, and I am still trying to work it out. The worst part about it is I have no idea what I could of done differently? I would see advertisements on all form of media. I heard President Obama on American Top 40, and Between Two Ferns. promoting the website I saw countless links on the Internet, and I saw a cavalcade of celebrities telling me to apply. In spite of all that I couldn't figure it out. I honestly feel defeated. I saw this, and to extent still see it, as something American's should be proud that we accomplish as a society. I should have been one of the people this helped out, but instead I find myself disappointed in my country and even worse in myself for not being able to figure it out.

     

New Start

       I remember having long conversations with returned volunteers about what it would be like to come home. The transition back to the states is harder than leaving is what we're told they day we arrive in country. In fact, one of the first things we were told by the staff was that you cry twice when you come to Paraguay, once when you say goodbye to your family in the states, and once when you leave Paraguay at the end of service. While I didn't cry in either situation both instances were extremely emotional. As I sit here now, having accepted a job in Washington DC,  on the precipice of starting a new experience after only having been home for three months, my Peace Corps service feels sort of like a dream.

       I never thought I would get a job as quickly as I did. Luck probably had more to do with it than anything. The process of getting a job in the states is a lot of hurry up and wait. You apply for a ton of positions online in a rush of inspiration and then wait for weeks on end in the hopes that you get to the next step or even receiving the courtesy of a rejection email. Then its rushing again once you finally hear something, but cannot remember what the job is because you applied so long ago. Making travel arrangements, figuring out logistics, and doing your best to present yourself in a way that makes you a hirable candidate. Then nothing again as you sit and wait to hear back. That process takes weeks, and you go back to your routine until you suddenly get a call back asking if you can start the next week as you try to figure out a way to uproot your life, review the employment offer, and attempt to figure out how in the hell you are going to get to the job on the first day. I need a place to live, I have no furniture, I don't have a clue how to move around in the city and the list goes on

       The crazy thing is that is normal. Most people I talk to can relate to that situation, so my feelings about how hectic and unnatural it all seems are muted a bit. The thing I keep coming back to however is that figuring out those types of challenges is what I did in Paraguay, but instead of analyzing a health benefits package or filling out an I-9 form I had to hand wash my clothing or rewire my electricity. The ability to adapt to new situations that I got used to in Paraguay is sort of the same as I open this new chapter of my life. What makes it different is not being familiar with it. In Paraguay I made sure that I took things in stride and dealt with problems as they came up. Day-by-day, managing expectations, and asking questions are simple ways to live, but are so applicable in a multiplicity of contexts whether that is in Paraguay or in the states. 

       I'd by lying if I said being back in America has been easy. Transitions are always tough especially when you account for the stark differences between the United States and Paraguay. Those differences are overwhelming and they take time to figure out. I know that I will eventually get more comfortable in my new surroundings in DC, but life never really slows down and the second you think you got everything under control is the second that something throws you for a loop.