The Untold Story of the Workers Who Make the Affordable Care Act Work

March 23 marks 14 years since the Affordable Care Act (ACA) was signed into law by former President Barack Obama. The ACA, as then-Vice President Joe Biden predicted, has been a lifeline for millions of Americans needing affordable health coverage. But behind the scenes of this policy success are thousands of contracted federal call center workers like us who help Americans access ACA benefits, and struggle to afford our own health care while being paid bare minimum wages. While the Biden administration has been clear about its commitment to creating “good jobs” with federal spending, the experiences of ACA call center workers spotlight a glaring failure by the Department of Health and Human Services (HHS) and HHS Secretary Xavier Becerra to follow through on that commitment.

The federal government operates the federal ACA marketplace and 1-800-MEDICARE through a $6.6 billion contract with a for-profit government contractor, Maximus. Under this contract, around 10,000 workers answer calls in 12 call centers, mostly in the South and Southwest, including Arizona, Florida, Texas, Mississippi, and Louisiana. Most of us are Black and brown women. Many of us, even those with years of experience, are paid at or near the minimum wage for federally contracted workers established by President Biden, and a recent survey found that 98 percent of workers living with children report that they cannot make ends meet on Maximus’ wages alone.

Although we spend our days at work helping our fellow Americans access affordable ACA health plans, many workers at Maximus, including both of us, can’t even take care of our own health needs with the high-cost health care coverage we’re offered. Outrageously, nearly 9 in 10 surveyed workers at Maximus report that they have medical debt and have avoided going to the doctor because of concerns about cost. Neither of us can afford the doctor visits required to adequately manage our health issues. On top of this, we both have medical debt from past visits that we’re still struggling to get out from under.

Members of the Biden administration have talked a great deal about their commitment to using federal resources to create “good jobs,” which pay living wages, have family-sustaining benefits, provide job security, respect unions and freedom of association and offer career opportunities. Our jobs are directly accountable to a federal agency, and the agency controls many things about our jobs, down to the scripts we must follow in every conversation, but our jobs do not meet even one benchmark for a “good job” according to the Biden administration.

Maximus is the federal government’s largest call center contractor, collecting nearly $5 billion in revenue in 2023, more than 85 percent of it from federal and state government contracts. This has been good business for the company’s shareholders and executives. From 2020 to 2023, Maximus spent more than half a billion dollars to benefit shareholders in the form of stock buybacks and dividends. While frontline workers struggled with rising costs and low wages, Maximus gave its CEO, Bruce Caswell, a 17 percent raise in 2023, bringing his total compensation to over $27 million since 2020. There is no reason that Maximus cannot offer its workers affordable health care and living wages.

Federal call center workers at Maximus began organizing our union with the Communications Workers of America (CWA) back in 2017. We have demanded living wages of at least $25 per hour, affordable health care and job security, and the ability to form a union without interference from our employer. But instead of meeting our demands, Maximus management has pursued a program of anti-union intimidation, causing us to file multiple unfair labor practice charges with the National Labor Relations Board. Some of these charges allege that Maximus management unlawfully called police on and has retaliated against workers for engaging in federally protected union activity, while others allege that supervisors interrogated workers and implied that we could be fired simply for exercising our rights.

In November, at the height of the ACA and Medicare open enrollment periods, 700 of us walked off the job in the largest strike in federal call center history. In December, we blocked the street in front of the HHS headquarters and were arrested in order to bring attention to the unacceptable working conditions facing federal call center workers. It appears that HHS Secretary Becerra has heard our demands; just last week, he said that federal call center workers “would like to get paid a decent wage … I don’t disagree with them.” The thing is, Secretary Becerra and his agency are the ones with the power to hold Maximus accountable.

The Affordable Care Act is a crowning achievement of the Obama and now the Biden administrations, but it has been built on the backs of workers like us who have been left out and left behind. We are not willing to stay silent and accept what we are given any longer. It is time for Secretary Becerra to put actions behind his words and live up to President Biden’s vision for good jobs, now.

Katherine Charles is mother of two and a bilingual ACA customer service specialist at the federal call center run by Maximus in Tampa, Fla.

Audrianna Lewis is a customer service representative at Maximus’ call center in Hattiesburg, Miss.

The views expressed in this article are the writers’ own.