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LINCOLN, Neb. (AP) — Sometimes the work Cindy Balliet did this past year touched her heart.
Balliet helped a woman with chronic back pain get enrolled in the new federal health insurance program.
The woman was then able to get implants in her spine that blocked much of the pain and allowed her to live a more normal life. She could walk at least to the mailbox and back. She could go to church. She could make her bed, things we take for granted, said Balliet.
The woman enjoyed cooking. So she baked Balliet a loaf of bread, the Lincoln Journal Star reported (http://bit.ly/1Aq2ffm ).
Balliet got other loaves of fresh bread, a universal gift of thanks, from grateful people she shepherded through the computer application process for the Affordable Care Act.
She also got candy and thanks and hugs. Lots of hugs.
Balliet was one of 50 people trained and licensed to help Nebraskans "navigate" the new health insurance system. She was one of nine navigators paid to work full-time at Community Action Partnership offices across the state.
Balliet came to Nebraska from Michigan when her husband got a job in Seward. She planned to work on obtaining a nursing home administrator license.
Instead, Balliet, who has a background in insurance sales, spent the last year helping people in the Lincoln area get health insurance through the new federal system, which was created in a political hurricane and launched with serious computer-related problems.
The Affordable Care Act, also called Obamacare, provides health insurance for people who don't have access to employer-sponsored insurance. Premiums are based on age, gender and smoking status only. There is no penalty for pre-existing health conditions.
There is also a premium subsidy for people with incomes less than 400 percent of the poverty level.
Some of Balliet's clients had been unable to afford insurance. She remembers a middle-aged woman with hypothyroidism who could not afford health insurance nor medication on a regular basis. The woman's eyes bugged out, a signal that she needed medical help.
With an Affordable Care Act plan the woman was able to get an ultrasound, a better diagnosis and more effective medication.
The woman's mother thanked Balliet and gave her an update when she came to the Community Action Partnership office in Lincoln for help on her own Affordable Care Act application.
More than 40,000 Nebraskans enrolled in Affordable Care Act plans for the first year, according to a report from the U.S. Department of Health and Human Services.
And on average, monthly premiums for Nebraskans who qualified for tax credits fell 69 percent, dropping the cost of the average monthly premium from $308 before tax credits to $94 after tax credits.
Balliet came to the job without deep political convictions about the new national health insurance plan. She knew insurance. She'd sold insurance. She knew some people had trouble getting health insurance.
"I just knew it was the law of the land and they needed someone to help them through a process."
But the experience of working with people who desperately wanted insurance they could afford made her appreciate the program, even with its initial problems.
This was a job that filled her heart and sometimes gave her heartburn.
"I didn't realize how many people did not have coverage. There were people who came here in tears. They had lost their house. They were paying $1,200 to $1,500 a month for their health insurance -- basically protecting their retirement assets. They were waiting for the day they turned 65 so they could get Medicare (a federally subsidized health insurance program for seniors)."
Health insurance should not be a privilege offered only to people who are employed, it should be something offered to everyone, she said last month, during her final weeks as a navigator. Balliet and her husband are returning to their home in Holland, Michigan.
Community Action Partnership of Nebraska, which helped more than 15,000 Nebraskans with the Affordable Care Act program via phone or in-person appointments, hopes to get a second year of funding to continue the navigator program for the next Affordable Care Act enrollment period that begins in mid-November, said Amber Hansen, executive director of Community Action of Nebraska.
Community Action also provided information about the health insurance program to an additional 28,000 through outreach programs.
The early days of Affordable Care Act were a nightmare. The computer system that people had to use to apply for the health insurance did not work at all the first month.
So Balliet started printing off paper applications, allowing people to begin the process.
Balliet remembers one man who came in six times before Thanksgiving to get help on the application.
He had a heart condition and needed to get on an Affordable Care Act plan before Jan. 1, when his very expensive, private insurance ended. He knew the plan he wanted, knew its cost. And as a software engineer, he knew computer systems.
So he was doubly frustrated, she said. He could see what they were trying to do with the system, but could do nothing on his end to fix the problems that kept him from finishing an application.
By Thanksgiving, the federal government worked out the most troublesome bugs, and the man got covered, Balliet said.
Not everyone was happy with Affordable Care Act.
The much higher premiums for smokers was a "hard pill for people to swallow," she said.
They felt like they were being punished for a habit while others were not punished for habits that also created health problems like overeating or drinking too much or using illegal drugs, she said.
And some smokers chose not to get health insurance because of the cost, she said.
She did not work with other disgruntled people whose private insurance plans were less expensive than Affordable Care Act plans, because those people were able to keep their plans for another year.
Most of the people she worked with were happy with the federal program. Balliet kept a box of tissues handy for the tears of joy.
People with a pre-existing condition who either had no insurance or had very expensive plans often needed to dry their eyes.
Older people, ages 55 to 64, people who were paying high premiums for private insurance and were too young for Medicare were also delighted with the program.
"It gave them a new lease on life. It was just unbelievable."
In Nebraska, 64 percent of enrollees who selected plans with tax credits had premiums of $100 a month or less, and 38 percent paid $50 a month or less after tax credits, according to the federal report.
The hardest issue was telling people they wouldn't get coverage because their income was too low, Balliet said.
It's called the Medicaid gap.
Nebraska state government refused to cooperate with the federal program by expanding the Medicaid program, funded by both state and federal government, to all adults with very low income.
These people could not get tax subsidies through the Affordable Care Act program because the federal government expected them to be using Medicaid. But they didn't qualify for Medicaid by the state's standards.
And the cost of the Affordable Care Act insurance without a subsidy was far more than they could afford. So they fell into the Medicaid gap.
"People were angry. They didn't understand." And neither did Balliet, she said.
She worked with a man who got health insurance for himself, at no cost, through work. The man's five children got health care through Medicaid, which treats children differently from adults and covers children in low- to moderate-income families.
The family income put them below the poverty line (less than $35,600) but the mother couldn't get Affordable Care Act coverage.
And it would cost an unaffordable $700 a month to add her to the husband's work health plan.
The other major problem was what Balliet calls the family glitch.
The glitch affected people whose employer provided health insurance and paid much of the premium cost for the employee but not for their family.
These families were not eligible for tax credits on Affordable Care Act plans unless the employer's health insurance premium costs were more than 9.5 percent of the family income.
So families, particularly those with many children, with modest but not low incomes, couldn't afford the employer plan or ACA.
That's one area where there should be reform, Balliet said.
And there were some exceptionally complicated cases, often involving people who are legal immigrants to the U.S., generally students and their spouses and children.
The children and sometimes a spouse would not have green cards or Social Security numbers, a situation the Affordable Care Act software didn't recognize.
But even U.S.-born clients had problems when their situation didn't fit the norm. Balliet spent at least 100 hours and had 200 pages of documentation on one case, an unusual situation made more difficult because the father and son had the same name.
The inflexible Affordable Care Act program did not allow them to use a middle initial, which would have helped differentiate the two.
"You've got to learn to be flexible and keep your sense of humor. People are doing the best they can, but it is a new system."
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Information from: Lincoln Journal Star, http://www.journalstar.com
This is an AP Member Exchange shared by the Lincoln Journal Star
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