I talk to peo­ple about Oba­macare. My job is to help peo­ple buy insur­ance if they’re mak­ing above a cer­tain income lev­el. So I’m basi­cal­ly an insur­ance bro­ker, except I’m paid by the gov­ern­ment instead of an insur­ance com­pa­ny. And I’m mak­ing a crap­py non-prof­it wage.

Greg Chern (a pseu­do­nym), a cer­ti­fied appli­ca­tion coun­selor at a non-prof­it health­care clin­ic, feels sim­i­lar­ly stymied when he helps patients sign up for health insur­ance through the Afford­able Care Act. Though many patients come in with urgent med­ical issues, he says, ​“Most of the time a sheep­ish smile is all I can offer that per­son. It makes me sad when peo­ple are sat­is­fied with what I’ve done, because it’s so lim­it­ed. I can help direct their con­cern to the right office, but they still have to nav­i­gate sev­er­al dif­fer­ent offices. But peo­ple are still appre­cia­tive — which makes me even more upset, because the bar of what peo­ple expect is so low.”

An active mem­ber of her union, Lilith believed that the office could be more effec­tive if the employ­ees doing the work were also in charge of pol­i­cy. When she spoke to Terkel, she was in the midst of pur­su­ing a project of her own rather than her assigned work, col­lect­ing sta­tis­tics on sex dis­crim­i­na­tion and edu­cat­ing women of their rights. ​“Offi­cial­ly I’m loaf­ing,” she said. ​“But, iron­i­cal­ly, I’ve felt more pro­duc­tive in the last few weeks doing what I’ve want­ed to do than I have in the last year doing what I was offi­cial­ly sup­posed to be doing.”

Among those Terkel spoke to was Lilith Reynolds, a project coor­di­na­tor for the fed­er­al government’s War on Pover­ty-era Office of Econ­o­my Oppor­tu­ni­ty (OEO). As a gov­ern­ment employ­ee, she explained, she used to believe that “[all of the rules and reg­u­la­tions] were cor­rect and it was my job to car­ry out these rules. After I got to OEO it became more and more obvi­ous to me that a lot of these rules were wrong, that rules were not sacrosanct.”

For three years in the ear­ly 1970s, jour­nal­ist Studs Terkel gath­ered sto­ries from a vari­ety of Amer­i­can work­ers. He then com­piled them into Work­ing, an oral-his­to­ry col­lec­tion that went on to become a clas­sic. Four decades after its pub­li­ca­tion, Work­ing is more rel­e­vant than ever. Terkel, who reg­u­lar­ly con­tributed to In These Times, once wrote, ​“I know the good fight — the fight for democ­ra­cy, for civ­il rights, for the rights of work­ers — has a future, for these val­ues will live on in the pages of In These Times.” In hon­or of that sen­ti­ment and of Work­ing’s 40 th anniver­sary, ITT writ­ers have invit­ed a broad range of Amer­i­can work­ers to describe what they do, in their own words. More ​“Work­ing at 40” sto­ries can be found here .

When I ini­tial­ly trained for the job, they couldn’t actu­al­ly show us what the Mar­ket­place was going to look like — it wasn’t up and run­ning yet — so the train­ing was more like, ​“Here’s how you greet a client.” It went over how to how to ask them ques­tions about their sit­u­a­tion, things like that.

By the time we start­ed sign­ing peo­ple up for the actu­al Mar­ket­place, some­times I would be dis­cov­er­ing along with the patient what the next steps were, sit­ting and read­ing it along with them and fig­ur­ing it out as I went. My job is to help peo­ple nav­i­gate com­plex web­sites. For a lot of peo­ple, the process is inher­ent­ly alien­at­ing. The ACA took the health­care sys­tem, which is messed up already, and then it added an appli­ca­tion and an online shop­ping sys­tem on top of it, and then more lay­ers of tax law and immi­gra­tion law on top of that. It didn’t actu­al­ly make the health sys­tem itself better.

A lot of peo­ple I see strug­gle with lit­er­a­cy, and I feel good when I can help them get through this process. But some­times I’m basi­cal­ly a screen-read­er, ask­ing ques­tions which are some­times awk­ward to ask: ​“Hey, are you or your 17-year-old daugh­ter pregnant?”

When some­one walks in and they haven’t gone to the doc­tor in a decade, they have to do a whole series of steps — A, B, C, all the way through G — to get health­care that’s cov­ered. My job is real­ly just to do A through the first half of B — help them fill out an appli­ca­tion and then send it some­where else.

Some peo­ple tell me infor­ma­tion about their health prob­lems. Part of the rea­son is that they see I’m a human face, and they want to impress upon me that they need that cov­er­age. But I’m only doing A through B, so all I can say is, ​“Yeah, that sounds like you real­ly do need cov­er­age, and I’m glad that you’re here.”

I hear that there are peo­ple design­ing user inter­faces to replace me. Basi­cal­ly, I’m just a very nice user inter­face, with a win­some smile (laughs).

Before this job, I knew that Oba­macare wasn’t a nation­al health pro­gram, and I knew that it wasn’t the end goal. I knew the gen­er­al cri­tiques of Oba­macare, but I’d heard that it’s a step in the right direc­tion. Since work­ing on this stuff, I’ve real­ized that it’s more a step in the wrong direction.

A lot of what I’m doing is fig­ur­ing out what’s going on, and then telling peo­ple I can’t help them. When I see patients who are undoc­u­ment­ed, for exam­ple, there’s noth­ing in the ACA for them, so all I can do is direct them to dis­count programs.

There are some aspects that are worth­while, like the expan­sion of Med­ic­aid. But gen­er­al­ly, it seems like we’re mov­ing things away from what a lot of peo­ple need. Many who are above the Med­ic­aid lim­it don’t agree with the government’s esti­mate of what ​“afford­able” means, and they don’t think the options on the Mar­ket­place make sense for their bud­get. There are peo­ple who don’t like the insur­ance they have at their job and thought they’d be able to buy some­thing bet­ter on the Mar­ket­place. Those peo­ple are kind of between a rock and a hard place.

I’m an insur­ance bro­ker, but in anoth­er way I’m actu­al­ly an out­sourced Depart­ment of Human Ser­vices office. Peo­ple can come to me to fill out the first part of a Med­ic­aid appli­ca­tion instead of going to the DHS office. So it’s a way of under­min­ing the pub­lic sector.

I find myself won­der­ing what’s hap­pened to some peo­ple after I see them. There are some patients who I know need­ed some imme­di­ate help. In the cas­es of med­ical emer­gency, I can request to expe­dite things. The Med­ic­aid office ini­tial­ly said it was going to take 45 days to turn around an appli­ca­tion. I was try­ing to get somebody’s appli­ca­tion expe­dit­ed because of a med­ical emer­gency, and the patient told me they were reject­ed [for the expe­di­tion] because it wasn’t deemed a med­ical emer­gency, which was B.S. I asked if I could appeal the deci­sion, or if the patient could, and DHS said they could appeal the fact that it took more than 45 days, but the appeal process would take more than 60 days.

As part of my ethics train­ing, I’m not sup­posed to priv­i­lege one insur­ance com­pa­ny over anoth­er. I’m not allowed to say, based on my exper­tise, what I think about dif­fer­ent plans. Which is kind of good, because I don’t real­ly have any exper­tise. But do I know that Blue­Cross BlueShield got more than 90 per­cent of sign-ups in the Illi­nois health insur­ance exchange, and I’m not able to say any­thing about it. All the ​“eth­i­cal” require­ments are just as much to pro­tect the insur­ance com­pa­nies as the patients.

When I explain that I talk to peo­ple about Oba­macare, often peo­ple who are my age, in their 20s, are like, ​“Oh, I have to talk to you!” I was just at a par­ty where some­one cor­nered me. It was a Sat­ur­day night, and I was already kind of tired, and I didn’t want to talk about insur­ance with this per­son. I can’t rec­om­mend one plan or anoth­er to them any­way, so I say, ​“Sor­ry, I can’t give you advice about that.”

Then they say, ​“No, I know, but what do you think?”

There are so many vari­ables that I can’t speak to, even if I were allowed to. I can define terms for peo­ple, but I can’t pre­dict. There are now 143 plans in the Mar­ket­place in my area, each with details to con­sid­er on things like deductibles, pre­mi­ums and so on. These fig­ures are prob­a­bly set by actu­ar­ies fig­ur­ing out what exact­ly the num­bers should be to make mon­ey, but still have peo­ple buy the plans.

Indi­vid­u­als don’t have an actu­ary to help fig­ure this out. So some­times I try to make actu­ar­i­al tables with them on the fly, and bring up spread­sheets to show them, ​“OK, this is you using your insur­ance in a real­ly bad year. This is you using your insur­ance in a year where you’ll be healthy.”

It’s a com­plete farce. On the sur­face, indi­vid­u­als have all these choic­es, but I can’t real­ly pre­dict what will be best, and the patient can’t either. That’s one of the prob­lems with the fact that all this is pri­va­tized. The peo­ple who actu­al­ly have the use­ful infor­ma­tion aren’t in the room.

Some patients are frus­trat­ed at me, which I under­stand because I’m the near­est tar­get. Some patients don’t think it’s my fault, but they’re like, ​“This is what everyone’s talk­ing about?” Some patients are just dis­gust­ed at that moment.

Some peo­ple I talk to about my job have heard about nav­i­ga­tors on the news, and if they’re Democ­rats who buy into the mes­sage that this is a first step towards an improved sys­tem, they say, ​“Oh, that’s so great.” A lot of peo­ple assume I’m doing real­ly good work, and I say, ​“No, I’m basi­cal­ly sell­ing insur­ance, but not get­ting a commission.”

And then they try to argue with me that I’m ​“help­ing the unin­sured,” as if I’m going out and cur­ing lep­ers. This is not a dis­ease; it’s a social prob­lem. I try to walk them through why it’s not fix­ing the prob­lems, and why it’s actu­al­ly even mak­ing things worse.

And then I’ve ruined Thanksgiving.