Yusuf Valera resents that he has to buy health insurance. He’s never had it, and he says he doesn’t want it now.
"I don’t have much of a choice. If I don’t do it, then they’re going to take money out of my taxes anyway," Valera says.
The irony is Valera stands to gain - in a big way - from the Affordable Care Act. Yet like most New Hampshire residents, he simply doesn't like the law.
According to the latest UNH poll, 52 percent of adults in the state disapprove of the Affordable Care Act, with approval ratings lowest among Republicans (5%) and Independents (27%). That’s why Republicans running for office continuously bash the law, while Democrats tend to tiptoe around it. Democrats, by the way, favor the law at a rate of 70%.
UNH Survey Center Director Andy Smith says a big reason people don’t like the law is that it forces everyone to get health insurance.
"Any time you have government telling you that you must do something, it’s going to raise people’s hackles," says Smith.
Things have been hard lately for Valera. He says he was fired from his job last spring when his employer discovered he had a criminal record. Since then, the only income he and his wife have is unemployment benefits – $260 per week.
Yusuf attended a recent class at the Manchester Community Health Center on insurance options under the Affordable Care Act. He tells the instructor he tried to get insurance through Healthcare.gov last spring, but he kept getting blocked out of the website, and ultimately couldn’t afford the plans anyway.
"So you are actually a really good example of what we’re trying now," Bararba Costa, the class instructor, tells Valera and his wife, Imane.
Costa explains that things have changed since Valera first applied. New Hampshire exercised its option to expand Medicaid under the Affordable Care Act. The expansion targets people who didn’t qualify under traditional Medicaid, but who also don’t qualify for subsidized insurance through Healthcare.gov. The state calls its Medicaid expansion the New Hampshire Health Protection Program.
Costa says she has met a lot of people like Valera - people still simmering from bad experiences with the federal website.
"Understandably that has affected their whole overlook of the process, and their trust," Costa says.
Getting people to sign up for insurance is about more than gaining trust. It’s also a logistical puzzle, says Lori Real with Bi-State Primary Care. Bi-State is funneling $900,000 over two years to so called “navigators” – people like Barbara Costa, out in communities, explaining the options to folks like the Valeras.
"In the northern part of state we’re challenged by people that might have difficulty with transportation," says Real. "In the central and southern parts of the state, we have refugees and immigrants and English may not be their first language."
A week after the class, Yusuf sits down with a social worker at Manchester Community Health Center. She punches his personal information onto a website known as NH Easy. In 20 minutes, the application is complete – a way simpler encounter than Valera had with Healthcare.gov.
And three weeks after he filed his Medicaid application, Valera and his wife had been approved.
"Yeah, this is good," says Valera. "This is one less thing to worry about."
Since enrollment opened up in August, the state’s Medicaid ranks have swelled to 20,000. And an additional 40,000 people got insured through Healthcare.gov in the first enrollment period.
Here’s the thing though. Valera is happy with how this has worked out for his family. But how does he feel about the health reform law itself?
"My attitude hasn’t changed as far as trying to force people to pay for something that they’re not going to use," says Valera.
So even though Valera will not paying anything out of pocket – in fact if he goes to a doctor now he's likely to pay less than he did before – he still doesn’t like the law.
And therein lies a political problem for backers of this law. Even people who benefit from the Affordable Care Act may simply not want to be told what to do, least of all by their government. And history suggests the people who stand to benefit the most from this law - the least affluent - are less likely to vote, particularly in a midterm election.