Almost one in 10 New Hampshire residents does not have health insurance. Yesterday, the state’s dominant insurer, Anthem Blue Cross Blue Shield, invited healthcare leaders from around the state to find out what that feels like. New Hampshire Public Radio’s Raquel Maria Dillon has more.
In a basement conference room at a Laconia hotel, several dozen professionals gathered to participate in a game of sorts – a game that has very high stakes in real life.
They’re participating in a simulation called “Walk in My Shoes.” It’s designed to reflect the complexity of getting medical care when you’re uninsured or underinsured. A Boston non-profit advocacy and policy organization called Community Catalyst created the simulation. They customized it to reflect New Hampshire’s uninsured population.
AMBI 119 loud room sound
Each participant gets a role to play – a single mom who doesn’t speak English, a receptionist at a doctor’s office, a middle-aged woman with a lump in her breast.
LEFAVOUR :18 I’m Fran LeFavour and I’m pretending to be a Haitian male who’s 31, I have 29yo wife, I have 3 children. A 13 year old who’s depressed. And 8 year old, and 6 month old who has hearing difficulties.
In real life, LeFavor is a human resources consultant and benefits manager.
At the beginning of round one – an imaginary week compressed into 15 minutes – she’s speed-walking around the perimeter of room.
LeFAVOUR :07 I’m on the bus, I don’t have a car. If I don’t have a car I have to walk around the room 3 times on the bus.
Meanwhile, Susana Chance, who’s playing LeFavour’s wife, makes a pretend phone call to someone playing an administrator at the state’s health insurance program for low-income children.
CHANCE :08 I’m trying to find out if our kids are eligible for Healthy Kids, but I’ve been put on hold and now I’m getting a busy signal so I have to keep calling.
This phone call is really just a series of cards flashed back and forth at the Healthy Kids station, where another participant is playing Administrator. She draws a random card marked “Busy.”
AMBI :11 let’s have you fill out that form first. And I’m going to need to see your health plan card. A health plan card? No.
The participants scurry back and forth between stations – the bus stop, the hospital emergency room, an HMO, a specialists office.
ER AMBI :10 if you don’t have insurance, we’re going to have to send you to the outskirts hospital, or you’ll have to pay $40 to obtain services here.
Next door at the Clinic station, Anthem’s real-life Medical Director, John Robinson is trying to make an appointment for his make-believe wife who’s having problems breathing.
ROBINSON :20 I’m playing Juan Garcia and I have lower back pain. This is my wife Anne Garcia.
MARSETT I’m Anne Marsett from the Avis-Goodwin Community Health Center.
ROBINSON we got turned away from ER, we needed to go to Dr’s office first and they couldn’t give us appt for her acute breathing problem until tomorrow afternoon.
Robinson’s character has only catastrophic healthcare coverage. The medication for his lower back pain will have to paid for out of his own pocket.
LeFAVOUR :05 so far we’ve been here 2 weeks and we haven’t gotten the kid to the doctor yet.
After another trip ‘round the room on the imaginary bus, Fran LeFavour is in line at the Specialists’ office.
SPECIALIST :10 good afternoon, valley specialists’ office? hello? Hello? Can I help you?
LeFAVOUR hello? need appointment!
SPECIALIST I can’t understand you.
LeFavour’s character, the Haitian agricultural laborer, doesn’t speak English, only Creole. The receptionist pretends not to understand her and calls for an interpreter.
LeFAVOUR :08 we wait now and wait for an interpreter comes over. They decide whether they can handle us on phone.
By the end of Week 2, LeFavour had found a short-cut in the system. Instead of holding up the line waiting for the interpreter, she went back to “Home” and fetched a large photo of a smiling child. This represents a kid from the neighborhood.
LeFAVOUR :21 I borrowed an interpreter kid because mine don’t speak English but if I pick up a picture of the neighborhood kid who would then speak English for me. one of us is gonna have to miss a day of work. Who ever makes less money or flexible schedule… Let me have this kid back
SPECIALIST don’t forget, tomorrow at 1pm.
LeFAVOUR after all this you think I’d forget?
ROBINSON :?? I was here and you took all my info yesterday but you never gave me the paperwork.
CLINIC Sir what’s your name?
ROBINSON Juan Garcia…
Also known as Anthem’s Dr. John Robinson…
ROBINSON :?? my wife has gotten appt but I haven’t and if I miss a day of work and if I don’t work then I don’t get coverage here. we’re making some progress but this lady forgot to give me the form so when I went to Dr.’s office they wouldn’t let me in. what’s gonna happen to my paycheck here. I’ve already been yelled out by my boss.
WHISTLE :??
The whistle blows – that’s the end of Week 3. And just like in real life – things get complicated. The organizers hand out “Chance” cards – one woman comes down with a severe case of the flu. The Pharmacy is requiring preauthorization for all prescriptions. And someone has started selling their Oxy-Contin to make ends meet!
Meanwhile the Emergency Room station is overcrowded. 7 people are waiting there, and Andy Patterson is arguing with the receptionist to get in.
ER :?? you can either pay for the services, or call provider see if they can authorize.
ANDY it’s not a matter of authorization with Medicare, in fact it’s a federal violation if you don’t see me. It’s called MTLA, this is an ER…
ER I’m sorry I’ve never heard of that.
ANDY clearly you’re in serious violation!
Patterson is the director of contracts for Lakes Region General Hospital. And he’s right about Medicare regulations. But it’s not clear that his character, an elderly gentleman with a broken leg and high blood pressure, would know that…
PATTERSON :?? I’m just a senior who’s 79yo doesn’t understand all of these federal regulations but I know there’s gotta be one that protects me. And I’m gonna write my congressman.
These participants are obviously knowledgeable about the healthcare system. They deal with it every day, sometimes they even set the rules… But without essential tools like a car and the ability to speak English, the usual hassles of getting a doctor’s appointment are magnified.
Afterwards, many participants counted their blessings. A show of hands revealed that only a few people actually got medical treatment. The participants who were paired up in a “family” fared better, as did those with some health insurance rather than none.
Anthem says the simulation was an exercise in compassion and understanding. Many of the concerned healthcare leaders who participated said they learned a lot. The chaotic healthcare system is a daily reality for many New Hampshire residents. For them, a trip to the doctor is more than a few trips around the room, it often means waiting for the bus in the cold.
For NHPR News, I’m RMD.
