When the Affordable Care Act rolled out last year, Californians enrolled in both Covered California and expanded Medi-Cal in high numbers. But there are still millions without insurance. Undocumented people don’t qualify for Obamacare benefits. Many others still find coverage too expensive or face other obstacles to enrolling.
One of those people is Leaburn Alexander. I meet up with him at 6 a.m. as he is finishing his shift as the night janitor at a hotel near the San Francisco Airport. He clocks out just in time to catch the hotel’s shuttle back to SFO, where he will catch a bus.
“Right now, I’m on the beginning of my commute,” he tells me. “After an eight-hour shift, my commute is like two-and-a-half hours.”
I accompany Alexander on his commute to East Palo Alto, about 20 miles south. It actually takes us three hours, on the hotel shuttle plus three more buses. He does this commute five days a week because he doesn’t have a car. The train would be faster, but it costs three times as much. Alexander has no wiggle room in his budget.
He says he makes just under $11 an hour, and after taxes, child support and other expenses, he brings home just enough to cover rent. And all the other bills? He has a second job to cover those. His wife has been looking for work for over a year, and his oldest daughter is in college. There’s no room in the budget for health insurance.
“When I first got this job,” he says, of his night janitor position, “they informed me about different employee packages, different benefits and all that.”
But Alexander says he can’t afford the employee portion of the premium. Many people who are working lower-wage jobs may qualify for Medi-Cal, California’s version of Medicaid, if their incomes are low enough. But because Alexander had been turned down for Medi-Cal in the past, he presumed he still wouldn’t qualify, despite the broader eligibility under Obamacare. He hasn’t had time to check.
Earlier this year, he went to get a physical at a community clinic, and they tried to sign him up for a county program. But even the $20 a month payment was too steep for his budget.
While he’d like to be insured, Alexander, 53, says he feels pretty healthy.
“I mean, there’s times where I’d be tired from fatigue and my age, a little arthritis, but I still feel pretty good,” he says. “But what might be going on inside of me is a different story.”
Alexander’s blood pressure is high. He got free pills free from a clinic and plans to return when he runs out.
The only time in his adult life when he had health care was when he was incarcerated. He had substance abuse issues and was involved in a bank robbery. He says he had tried recovery programs, but didn’t succeed, until he became a born-again Christian.
“That was divine intervention. It really happened,” he says. “I’ve been clean and sober since July, 2011.”
The Remaining Uninsured
Uninsured Californians fall into a few categories, says Laurel Lucia with the U.C. Berkeley Labor Center. One is called the “family glitch.”
“Basically spouses and children who can get coverage through a family member’s employer but it’s too expensive,” she says.
Sometimes the employee part of the premium is affordable, but the family coverage is much higher. But because the employer made an offer of insurance to family members, “(w)hen they go to Covered California they’re told they’re ineligible for subsidies,” Lucia says. It’s part of federal policy.
A second uninsured group is people who are eligible for subsidies through the ACA marketplace — but they still find the premiums unaffordable.
Finally, Lucia says there may be nearly 1 million Californians who are eligible for Medi-Cal but don’t know it, or have had difficulties enrolling.
It’s unclear exactly which category Alexander may fit into.
The Enrollment Counselor’s Perspective
Over in East Palo Alto, Irais Bazan is an enrollment and eligibility manager at the Ravenswood Family Health Clinic. Bazan has met people in all of those uninsured categories — and more.
“Situations can change at any minute,” she said. “So we’re adamant with clients, any changes, as little as you may think” must be reported right away. “Sometimes these rules for these programs change.”
And someone who thought he wasn’t eligible for Medi-Cal or subsidies before may be eligible now. That may describe Leaburn Alexander. But while coming back to the clinic sounds like a minor hassle to most people, for Alexander, it’s a big barrier.
“Scheduling time to do that, an appointment. It’s kind of rough, kind of hard right now,” Alexander says.
Just as Alexander has no wiggle room in his budget, he has precious little extra time in his schedule. After he wraps up his overnight janitor job, he heads to a second job, washing dishes at a Stanford dining hall. He has one full morning off each week, but that time is taken up with other needs of daily life.
“Come Wednesday,” he says, about his morning off, “that’s when my pastor comes and gets us and takes us grocery shopping.”
Alexander remains optimistic that his situation will improve.
“I’m hopeful that through prayer that God will bless me with a better paying job,” he told me.
–Lisa Morehouse
Lisa Morehouse produced this story while participating in The California Endowment Health Journalism Fellowships, a program of USC’s Annenberg School of Journalism. This story is part of a reporting partnership that includes KQED, NPR and Kaiser Health News.
m&m says
That’s Obama care. We’ll read what’s in the bill after we pass it.. I have never met ,or they don’t admit they voted for Obama.
Sarah says
I created a petition to the White House addressing this problem. If you agree that the 9.5% formula needs to be modified to include the cost of insuring the rest of the family, please sign! If we can get 100,000 signature by Dec 19, the White House will respond. Thank you!
https://petitions.whitehouse.gov/petition/fix-family-glitch-affordable-health-care-act/kqGwHzqr
Groot says
Hmmmm, interesting. I’ll try submitting a review agan, last time and time before that, it was not published because it was critical of Obamacare. My wife works for a smaller employer here, the employer has been careful to cut off all but management employees at 39 hours or less on pain of termination. She is now paying $380+ for her ACA compliant independent policy premium with BC/BS. Flagler County had one of the highest increases in the country for premiums, 17.8%. Prior to Obamacare, she paid about $120 a month. Her employer is not offering an employer sponsored plan and has no intention to do so. Most of her fellow employees do not have insurance, they plan on just paying the penalties since the premiums are so high in Flagler County. A lot of folks are falling between the cracks. I hope we have a voice here. I doubt it. Objectivity is a good thing, it shows honesty and interest in other fellow citizens and an eagerness to learn.
Anonymous says
Perhaps his pastor can assist him with this matter as well. Lord knows, Rick Scott and the Republican legislature of Florida won’t.
Marvelous says
My four kids and I fall into that family glitch. Sad how such a major law can have huge gaps in coverage.
Anonymous says
Groot–Employers like your wife’s are the greedy bastards here. Since they do not plan to devise any new system of health care coverage for their employees (how caring of them), do you know if they plan to rebate the profit they will be making from their decision to take advantage of Obamacare loopholes back to their employees in any way, shape or form? My bet is, they will not. So, why don’t you reserve some of your righteous wrath for them?
The Real Bunnell Resident says
I have an idea for this gentleman. He can exercise his rights under a competitive labor market. Look on indeed.com and find another job, preferably in another state that doesn’t cost so much to live in. He would do just fine in many places making $11 an hour for one full time job plus working a second job to round out the budget. I worked 80-100 hours a week for many years without complaining one bit. All those commute hours he suffers through could no doubt be put to better use by living and working in a more affordable place. Problem solved!
Sherry Epley says
M&M. . . I proudly voted for President Obama, TWICE. . . so did the majority of my friends. . . AND, if you’ll remember. . . so did the “Majority” of the voters in the USA. . . TWICE!
Again, our state government Republican leaders are to blame for the high cost of health insurance in Florida, not the ACA! Rick Scott signed an order taking away the authority of our Insurance Commissioner to regulate rates here! Remember he also has refused to extend Medicaid! Also, greedy employers are to blame for finding and using the loopholes to avoid covering their employees for health insurance. Let’s use facts and common sense to place the blame for higher rates/less coverage where it really belongs.
The Real Bunnell Resident says
Obama was twice elected by a coalition of the pathetic mesmerized by an orchestrated campaign of deceit directed from the White House.
Anonymous says
Ooohhhh, it’s an organized plot! Just like Rush Limbaugh and FOX news say it is! Talk about people who are “mesmerized” by “campaign(s) of deceit!” Only some of them are orchestrated by people like the Koch brothers. Big money has no problem buying little minds.
Anonymous says
The brain-washed constant watchers of FOX news and listeners of Rush Limbaugh are always the first to call other people “sheep” who have been “mesmerized” by “orchestrated campaign(s) of deceit.” I believe the term “pot calling the kettle black” definitely applies here.
Joe says
Reps and Dems always fueding on here, your both part of the problem, the question is a simple one, are we better off now with these new health care laws or not?
Anonymous says
Actually, Joe we ARE better off, as more people than ever before now have insurance (and, therefore, can get their healthcare needs met) and healthcare costs in the market are beginning to come down, instead of inflate, which they were doing, more and more each year, before the advent of the ACA. I hope that answers your question (it does–but probably not in a way you would ever choose to hear.)
Doug says
Rick didn’t take billions of dollars from the federal government to help out with health care in Florida. It’s our money the federal government was going to give back. Why didn’t he take it? “Good” health insurance runs about 25 Grand a year for a couple. I don’t understand how anyone can afford decent insurance. Rick’s help might have made it a little easier though.
I like the idea of ACA but until corporations bring jobs back to this country we will still be sucking on the hind tit.
Doug says
Rick didn’t take billions of dollars from the federal government to help out with health care in Florida. It’s our money the federal government was going to give back. Why didn’t he take it?
“Good” health insurance runs about 25 Grand a year for a couple. I don’t understand how anyone can afford decent insurance. Rick’s help might have made it a little easier though.
I like the idea of ACA but until corporations bring jobs back to this country we will still be sucking on the hind tit.