What it’s like when someone gets health care for the first time

Andrew Shell, a patient navigator at Whitman-Walker Health in Washington, D.C., talks about how the Affordable Care Act has impacted his job and work life. (The Washington Post)

(Working Stories is a recurring series of pieces in which we collect stories of how and why people work. This has been lightly edited for clarity.)

“I’ve always been drawn to the idea of public service. Giving back to the community, that sort of thing. One of my grandfathers was a career Army officer. The other is a minister. They’ve always inspired me.

A lot of people I see are HIV positive, and we’re connecting them to health care for the first time, or helping them restart health care they couldn’t afford to keep up.

Things have changed a bunch since I started, thanks to the Affordable Care Act. Now, people can come in off the street and walk up to the front desk and say ‘I have a problem with my insurance.’ They don’t have to be patients. We will help anyone.

What makes me good at my job? A mind to learn details and remember key facts. The most important thing, I think, is being able to explain things without getting into the minutiae of policy. It takes empathy to put yourself in a person’s situation: What are they interested in? What do they need?

My job is a combination of advocacy, research, education and outreach. The patient population is incredibly diverse linguistically and socioeconomically. Different sexual orientations. Different people have different needs. You have to stay on top of stuff to meet as many as possible.

I help them understand health insurance options, Medicaid and Medicare. The options can be radically different, depending on if they’re from D.C., Maryland or Virginia. I explain their benefits, connect them to social services and send in the applications myself.

Some people who come in have no idea about insurance. Some have never had insurance. Or they don’t understand how insurance works. I try to explain their options and figure out what they’re eligible for. It gets complicated.

The ACA added a whole new dimension to our work. All the exchanges had glitches during the first open enrollment periods. There are still definitely some glitches. It’s been frustrating to work through that. But now, with all the media coverage, Obamacare is more prominent in the public discourse. More people are aware health insurance is an option now. They know Medicaid has been expanded in D.C. and Maryland, but not Virginia. They want to find out: What are my options now? What do I have to do?

I try to lay the field out for them.

The most rewarding part is watching someone’s health actually improve. Sometimes, I see a patient and they look gaunt. Six months later, there they are, waving at me in the lobby. I watch their health rebound. They recover.

That’s when it clicks like, “Wow, they look good. They really do.”

Danielle Paquette is a reporter covering the intersection of people and policy. She’s from Indianapolis and previously worked for the Tampa Bay Times. Follow her on Twitter: @Dpaqreport.
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