Originally posted by The Martinsville Bulletin on April 1, 2015.

Last month marked the five-year anniversary of the signing of the Affordable Care Act (ACA), and according to representatives of two area organizations, the act has helped many people in Henry County and Martinsville gain health insurance.

President Barack Obama signed the Patient Protection and Affordable Care Act (popularly referred to as “Obamacare”) into law on March 23, 2010. The government health insurance exchange website healthcare.gov went live in October 2013.

According to information provided by Virginia Organizing, between Nov. 14 and Jan. 16, a total of 1,739 city residents signed up for a 2015 Health Insurance Marketplace plan. Data on the number of Henry County residents who had signed up was not available.

Barbara Jackman of the Martinsville-Henry County Coalition for Health and Wellness said that at the coalition’s federal-qualified health center in Bassett, many patients come in who are uninsured and struggling to obtain basic health care. The coalition helps connect people with health care services and physicians through various “safety net” programs.

The coalition also has employees — Sarah Bowman and Rita Winbush — who assist area residents in signing up for health insurance through the ACA.

There are a number of misconceptions about the ACA, Winbush said. Often, people hear that someone they knew applied for coverage and it was prohibitively expensive, or they apply themselves and become discouraged without realizing that they’re eligible for federal subsidies that would reduce the cost.

“Every person’s situation is different,” Winbush said. “Someone may tell you, ‘I checked and it’s going to cost me this amount,’ but their income level, their family situation, their work situation, all of that is different.”

“People need to check their own individual situation, regardless of what they’re hearing out there, regardless of what may have happened to someone else, regardless of what they’ve read, or heard on the radio … or their political affiliation, and not cut off their noses to spite their faces,” she added.

Lois Hairston, who is a member of Virginia Organizing, agreed. Virginia Organizing is a nonpartisan statewide organization that works to promote social and economic justice for Virginians, Hairston said.

For many people nationwide, Hairston said, “Obamacare” has become a dirty word.

“If we are going to rescue the spirit of bipartisanship, then let’s just look at the facts on the ground and come together on things that really are good ideas,” said Daniel Willson, also a member of Virginia Organizing. “And the Affordable Care Act has a lot of good ideas.”

Bowman and Winbush said there have been many occasions when someone has arrived at the coalition firmly opposed to the ACA and all it stands for, only to find that by signing up with the health exchange, they would be able to save a significant amount of money.

Willson even told the story of a local family of six that left their employer’s insurance plan, joined the health exchange, found they were eligible for federal subsidies, and reduced their premium by 90 percent.

Locally, Winbush said, the people who most often join the health exchange are not the chronically unemployed, but local residents who were downsized from the furniture factories and knitting mills where they once had employer-based insurance.

“They didn’t just wake up one day and not work,” Winbush said. “When they were downsized, they lost their benefits, so then they had to regroup and find access in the safety net arena. Now, (the ACA) helps them get out of that.”

“Having insurance brings some consistency to a person’s life,” Jackman added. “They can work, they can have their income, they know what their monthly premiums are. … This consistency leads toward people having jobs, earning money, being responsible for putting money back into the economy and doing the things they need to do, which is what everybody wants.”

The health insurance environment of today is quite different from what it was a decade ago, Jackman said, because the nature of employment is changing. More people are self-employed, working part-time jobs, doing freelance work or working at small businesses that do not offer insurance.

“It’s not like the health care system in the United States was really functioning well five years ago,” Jackman said. “I think there are probably lots of criticisms of the Affordable Care Act that have been valid … but overall, it was a step toward addressing a system that was not just broken but fast becoming non-functional. … You had masses of people going to the emergency room to seek the most expensive and, except in an emergency, the less effective treatment for (conditions that should be treated by) a primary care provider. But you can’t get one if you don’t have insurance, and in a community like this, where we lead the state in unemployment, there are a lot of people who don’t have employer-based health insurance. What are they going to do?”

In the beginning of the ACA, Jackman said, there were supposed to be two pathways to ensure people would have access to primary care: one path was the health marketplace, and the other was an expanded Medicaid.

However, she noted, Virginia has chosen not to expand Medicaid coverage, causing a large number of area residents — about 80 percent of the people seen by the coalition, Jackman estimated — to fall into the so-called “Medicaid Gap.”

As a result, Jackman said, those people end up in safety net programs and find themselves surviving “crisis to crisis.”

“They’re looking to get back to normal,” Winbush said. “These are people who worked, and maybe they had company-provided insurance and they paid into that insurance, but then when they were downsized and companies left, they lost those benefits. Being in the safety net arena, whether it’s free clinics or sliding fee scales or grant-funded programs … that’s not really their norm. They want this insurance to be able to get back into what they were used to and to be able to pay their own way.”

Five years out from its initial signing, Jackman said, the ride has not always been smooth, but the ACA has helped a large number of people receive much-needed insurance. In Virginia alone, around 385,000 residents have insurance through the marketplace, and about 318,000 receive federal subsidies.

“It’s a step forward,” Willson said. “There are more steps to take, but it’s a step forward.”