PORTLAND, Maine — It was no normal bagel-and-knife mishap that put Owen Marshall’s career and marriage in jeopardy.
Marshall, a musician by trade, had already sliced the bagel in half a couple days before, without incident. He then put the bisected breakfast treat in the freezer. Pulling it out again a few days later, Marshall picked up the same sharp blade and tried to pry the two frozen halves apart.
That’s when he slipped. The knife tip plunged into his left hand, severing both of his little finger’s flexor tendons. Marshall immediately headed for a nearby urgent care center.
“It didn’t bleed much,” he said, “But then they wanted to move my finger, and I almost passed out. The realization of what happened was crushing.”
The injury would eventually keep Marshall out of work for six months. It also led him into an insurance black hole known as the Affordable Care Act’s “family glitch.”
Marshall would soon lose his ACA insurance subsidy because he had just gotten married. Without the subsidy, his premiums and deductibles soared at the same time his medical bills piled up. Without work, Marshall’s friends had to organize a fundraiser to help him get by. He finally got back to work this month but still faces hard choices. The only sure way to get his affordable health care back, is to get divorced.
Marshall makes his living playing and teaching Celtic music. Adept at both guitar and bouzouki, he’s a highly sought after accompanist. Marshall works with some of the most famous names in the genre. He tours nationally and internationally. Marshall grew up in Vermont but now calls Portland home.
Though it’s not used much in normal life, his little finger is vital to his music playing. Marshall was forced to cancel all his immediate gigs, including a tour and video shoots with Seamus Eagan — one of the best-known names in the business.
“When I was in the emergency room, they told me I was going to be out for four to six weeks,” Marshall said.
But the estimate kept going up. The surgeon who repaired his hand said six to eight weeks. His occupational therapist said 10 to 16 weeks.
Though discouraged at first, his surgery and physical therapy went well. By the end of August, he was cleared to play again.
That’s when things got worse.
“I had just started my first set of hand-strengthening exercises, and I heard a snap,” Marshall said. “It was a loud pop. I couldn’t move my finger at all. It was done.”
He was forced to go through the same surgery and therapy again. Just a few days before the setback, his wife, Liana Wolk, stumbled into the ACA family glitch.
Wolk called to tell insurance administrators about Marshall’s change of life status, from single to married. The officials asked if he was now eligible to go on her employer-provided insurance. She said he was but it would be far too expensive.
They said the cost did not matter. If he had access to other insurance, his was no longer qualified for his ACA subsidy. What’s more, they informed her his deductible would be reset — at a much higher number — immediately. With his second round of medical bills and time out of work about to double, the news was devastating.
“That was a bad week,” Wolk said, “Knowing the the system was just completely screwing us.”
Marshall’s subsidised plan had him paying $40 a month in premiums with a $700 deductible. If he had gone on Wolk’s insurance, provided by her employer, Portland Adult Education, that would have shot up to $1,300 per month to cover both of them. For her alone, it’s just $120 each month.
As a self-employed musician, Marshall’s only choice was to remain on the ACA, minus the subsidy. That puts his premiums at $415 a month with a deductible reset at a whopping $5,800.
“It was a real kick in the teeth,” Marshall said. “We weathered the first injury OK. We made it through two months of me not working — it was now going to be five or six months of me with no work.”
Marshall and Wolk are not alone in their struggle to navigate the ACA family glitch according to Kate Ende of Consumers for Affordable Healthcare, an advocacy and education organization based in Augusta.
Ende’s organization is currently trying to count the number of Mainers affected by the glitch and hopes to have the numbers in early 2020. She said current national estimates put the number between 6.1 and 10.2 million Americans caught in the gray zone. Those numbers include spouses and children.
“These are just working families that, through no fault of their own, become ineligible for the subsidies,” Ende said. “Even though, based on income, they should qualify.”
It’s called a glitch but it’s not clear whether the gap between coverages was intentionally woven into the ACA.
“I’ve heard it was an oversight, but I’ve also heard it was a cost-saving mechanism,” Ende said. “To be honest, I don’t know what is the truth.”
Regardless of its origins, Ende said there’s currently no good solution to the problem, no workaround and no national legislation in the works to fix it.
In a cruel twist, the only sure way for Marshall to get his ACA subsidies reinstated would be to divorce his wife of six months.
“Divorce seems to be the only solution,” Marshall said. “We don’t know what we’re going to do yet.”
“Which sucks,” Wolk said. “The system has decided we need to pay $10,000 a year more just because we’re married, and I have a job that offers health insurance.”
Ende confirmed that Marshall would again be eligible for his ACA subsidy if he were single.
“And we’ve seen people do that,” Ende said, “Which seems crazy — not that we advise them to do that, but we’re happy to walk people through various scenarios.”
Fortunately, for Marshall and Wolk, their friends came to the rescue, for now.
When word got out about Marshall’s worsening predicament, his musical friends started an online fundraiser that netted $23,000 in a week. Donations came in from six different countries. With the addition of a September benefit concert in Portland, the total jumped to $27,000. Their original goal was $17,000.
“It was crazy,” Marshall said. “It’s making me emotional right now, just thinking about it.”
The money covered all his outstanding bills, as well as his summer’s lost wages.
Doctors once again cleared Marshall for work at the beginning of December. Currently, he’s working with a celtic Christmas show out of Boston.
“I’ve been playing every day and it’s getting there,” Marshall said. “My hand is getting stronger.”
Marshall said he knows he’s lucky. The glitch could easily have bankrupted him — but it didn’t, thanks to his caring friends. He thinks a lot about other people, in the same predicament, who don’t have the same resources.
“It’s not hard to imagine someone who doesn’t have this amazing network and community of musicians. There’s so many people who would not be able to rebound from this sort of thing,” Marshall said. “In my case, I’m someone who has some recognition, a lot of stage time, I’m talented — and those are the things that made it OK for me. That’s really messed up.”