Expanding Insurance Coverage through the Marketplace by Jessica Vadaketh

“If it wasn’t for the Marketplace, I wouldn’t have any medical insurance”. As an Insurance Specialist at Health Center #6, I have heard this statement many times. Health Center #6 is one of eight Philadelphia Department of Public Health (PDPH) Ambulatory Health Centers located throughout the Philadelphia area. The goal of PDPH is to increase access to care for  all Philadelphians.

Open Enrollment for the Marketplace started November 1st and just ended this past Saturday, December 15th.  Marketplace coverage has expanded insurance coverage for many Philadelphia residents. I have seen it specifically benefit two specific categories of patients: those who make too much for Medical Assistance and those who are new immigrants and have not had qualified citizenship status for at least five years. Additionally, many of these patients’ jobs do not offer insurance coverage either. This leaves many uninsured, without any options to obtain coverage. In this past Open Enrollment cycle I was able to personally apply for approximately 100 patients and their family members. As the Marketplace Open Enrollment comes to an end, I started to reflect on the number of patients this insurance program has benefited. I saw patients with acute medical conditions that need immediate attention, patients with chronic ongoing diseases, as well as healthy patients all receive insurance through the Marketplace. The need for this type of program is vital.

When I think of the patients I am encountering daily, many of them are in dire situations and need medical insurance.  One family in particular crosses my mind; a couple came in pretty early on in my service term and the husband needed an emergency surgery performed. This couple did not have many options when it came to obtaining healthcare coverage. They would not qualify for Emergency Medical Assistance due to their income and citizenship status, but could certainly not pay out of pocket for the surgery. I found myself frustrated trying to navigate the insurance options for this family. I found myself discouraged that although this was a husband and wife with two children and many bills to pay that they were constantly being told they made “too much money” to get insurance for an emergency procedure that kept the couple up at night. However, the only solution was that they wait for Open Enrollment and get insurance through the Marketplace. Luckily, this man was able to wait two more weeks for the Open Enrollment period to enroll in insurance and the surgery was scheduled once they were enrolled.

Throughout my short time being at Health Center #6 I have seen the value in the Insurance Specialist role. This position helps the patient navigate through the complicated insurance process in this country. Although not all are able to get insured through the current insurance programs available, I see the huge impact that insurance makes in many patients’ lives. Patients have left me in tears, thanking me profusely for helping them to understand and enroll in the Affordable Care Act (ACA).  It has been such a rewarding experience and I am sad this option is limited to only a few weeks in each calendar year.