The English phrase “tax credit” sticks out of a string of Nepali words as Prem Biswa tries to explain the intricacies of the federal health insurance exchange to his uncle, Dhak Rasaily. Rasaily has come to the South Ave Community Center with his wife and son to enroll in a plan with the help of Shannon Kelly, a health insurance assister from Trillium Health.
Born in Bhutan, Rasaily was part of a group of over 100,000 ethnic Nepalis who were forced to leave the country and lived in refugee camps in Eastern Nepal. After almost 20 years in the camp, Rasaily and his family resettled in Rochester in 2011. He speaks a little English, but not enough to make an informed decision about marketplace insurance plans.
Understanding the basics of the Affordable Care Act, like the difference between Medicaid and Medicare, is challenging even for many of Kelly’s English-speaking clients, she says. Limited English-speakers like Rasaily can call the marketplace hotline where many different languages are available, but they have to request the navigator in English. A bigger barrier is that many people don’t know the services even exist.
Rasaily worked as a traditional healer in Nepal—a ‘jumping doctor,’ he says. He still spends his days off from his job at the Grey Metal factory treating other local Bhutanese with problems like infertility. But Rasaily’s wife, Khina, has a range of complex medical conditions he can’t treat. She pulled a Wegmans shopping bag out of her purse full of pill bottles.
“One for headache, one for heart, and other for dizziness,” Biswa interprets for her. “Too much. Diabetes, blood pressure.”
The Rasailys were on Medicaid before, but for the past three months they’ve been paying for her medications out of pocket. Rasaily estimated they spent more than $600 a month. They hoped to be eligible for Medicaid on the exchange, and Kelly enters their income information to find out. Even with an interpreter, this is tricky. For example, the Rasailys don’t know the exact name of the company where their son works. After a few guesses, and the hint that he makes water bottles, Kelly does some googling and comes up with Thermo Fisher.
Rasaily earns too much to be eligible for Medicaid, but will be eligible for a $588 tax credit, Kelly tells the family. This subsidy only helps pay for the plan though, not his wife’s medications.
Then Rasaily has the idea to just get coverage for his wife, thinking it should be cheaper to cover just one family member. He and his son can get coverage through their employers and she has the greatest medical needs.
Kelly changes the application. Now with just one person enrolled, the family will only save $23 in tax credits. The Rasailys and Biswa are deflated. Rasaily changes his mind and Kelly changes the application again. With everyone back on, the family will have to pay around $250 a month. But then Kelly brings up deductibles, and the cost of prescriptions. She tells them about co-pays for primary care, and higher copays for the specialists Khina sees. Even at this point, an hour after they started, Rasaily remains confused over whether he needs to pay $250 per month or per week. Visibly frustrated, the family go back and forth over whether to enroll.
Kelly’s computer battery is about to die so she suggests the family write down their medical budget and finish the enrollment on a different day. But Rasaily decides he just wants to get it over with. He doesn’t know when he’ll have another day off from work and lacks the computer and language skills to finish without Kelly’s help.
By this point, Biswa, the nephew/interpreter is beat too. “I think in this America, we face very difficulties of language, anywhere,” he says as Kelly finished the enrollment. “I understand like 10%, not more than that,” he admits.
Kelly interrupts him with good news, “You’re enrolled!” Not understanding the English, the Rasailys are initially confused. But then, smiles abound.
“If you get home and you’re like, Oh my God, I made a huge mistake, we have 30 days to change this.” Kelly assures them. “But you won’t. This is a great choice.”
Kelly plans more drop-in hours like this, but unless the word really spreads, many new Americans may be left outside the system.