Next Monday is the deadline to sign up for health care under the Affordable Care Act (ACA), if you don’t already have insurance you want to stick with. Here in New York City, we at Persist Health Project, a peer-led group that connects sex workers with non-judgmental and affordable health care, have been linking our friends and community members up with ACA “navigators” (grant-funded folks who walk you through the application) from Callen-Lorde Community Health Center, our local LGBTQ service provider, to help them through the process. We’ve also partnered nationally with the Sex Workers Outreach Project Chicago (SWOP) and HOOK Online to offer anonymous, online chats about the ACA to answer questions, get folks signed up and help them get into care that works for them (the final chat before the deadline is this Thursday, March 27th at 10 pm EST).
In the process of chatting with sex workers about the ACA, people have talked about various roadblocks they’ve had, especially around having to report income, which is one of the essential steps in insurance enrollment. As one community member told us, “The first thing they did was ask about my income. I just quit right there. I still don’t have insurance.” Getting insured and finding health care can be a frustrating process for anyone, but it’s particularly trying when you don’t feeling comfortable sharing how you make money, or may not even be certain how much you make in order to report it. Most people in the US have had some kind of trouble signing up on the Healthcare.gov site by themselves, and it’s also a time-consuming process (they estimate it takes about 45 minutes to an hour and half to fill out everything, and that’s with an ACA navigator assisting you).
Many of the sex workers we have set up with insurance in NYC (as well as many of our staff members and volunteers) qualify for Medicaid, based on their reported income (or simply based on their actual income, whether it has been reported in the past or not). New York is also one of the 26 states to expand Medicaid coverage, meaning that more people will be eligible for Medicaid and able to enroll in it after the March 31st deadline. As Colorlines pointed out, though, since states were permitted to decide for themselves whether or not to expand Medicaid, many states where working poor are least able to pay for insurance as, unsurprisingly, also the the states that have opted out of the expansion.
Also, even after folks get enrolled, it’s still a challenge to get people what they need after they are signed up. Under the ACA, many more people are qualifying for Medicaid than ever before. However, mental health providers who take Medicaid are often stretched very thin; in NYC, there’s also only a few we know of who are affirming for people in the sex trade. Access to a provider who takes Medicaid may not mean you get the care you need and if you experience discrimination based on your status as a sex worker, it’s unlikely you’ll go back, no matter the cost. So folks may still have to pay out of pocket for a therapist or psychiatrist, if they want to see someone quickly.
The way that we’ve dealt with this in NYC is by working with navigators we trust (usually, working with a local LGBTQ center is a good start, or if you’re lucky enough to have one, a local sex worker organization), and offering them feedback when things go wrong in the process for a sex worker we have connected with them. It’s the same thing we do when looking for health care providers: we vet the providers as an organization, screening them to work with a range of people in the sex trade, then use them as a referral, offering them feedback as needed. The process of enrolling in insurance is daunting, when it means facing any anxieties you may have about money, work, or your health. But the ACA is changing the landscape for sex workers, as far as health care is concerned. It has the potential to shift the dialogues we as a country are having around health and health care. If everyone is entitled to health care, regardless of their ways of making ends meet, health care is presented as a basic human right, rather than something that’s just unrealistic for a large portion of the population. While access to health care options that work well for everyone is still a work in progress, getting signed up for health insurance may allow sex workers to re-think our relationship with health care. It’s very far from perfect, but the more sex workers there are getting the health care we need, the harder we can push back on the health care systems that have long said we don’t deserve, or aren’t entitled to, our care.
To get signed up in New York state, contact Persist Health Project at 718.635.1791. If you live elsewhere and have questions, join the final chat before the deadline today, March 27th at 10 pm EST.
Sarah Elspeth Patterson is the Executive Director of Persist Health Project, a peer-led health organization in New York City which links sex workers, trafficking survivors and anyone who has traded sex for money, food, drugs, or other resources with nonjudgmental health services.