Obamacare Call Center Staff Strike Over Steep Health Care Costs and Scarce Bathroom Breaks

Staff at US federal contractor Maximus claim they only get six minutes a day to use the bathroom, are monitored by an AI system that reports them for going off script, and can’t afford health care.
People striking while holding various signs and raising their fists
Maximus call center workers on strike in Bogalusa, Louisiana in June of 2022.Courtesy of CWA/Call Center Workers United

Katherine Charles’ work days are relentless. She’s one of thousands of call center workers who help Americans find suitable health insurance as part of the Affordable Care Act, or ACA. Charles spends all day on the phone, with only a six-minute daily allowance to use the bathroom. She also gets two 15-minute breaks and a 30-minute lunch period.

Charles and her colleagues are currently in the midst of open enrollment, the period during which millions of Americans purchase, switch, or join ACA or Medicare health insurance plans. In early November, Charles lost her voice from incessant talking and had to take two sick days. Call center workers are monitored by an AI system that sends reports to management if they go off script, or if a worker’s poor internet connection leads to a low-quality call. Though Charles spends her days helping people find affordable health care, she doesn’t feel she has the money to properly look after her own health.

So now Charles and many of her colleagues at Maximus, the federal government’s largest call center contractor, are going on strike. Today, hundreds of Maximus workers in seven southern US states walked off the job. Among their demands are higher wages, more affordable health care plans, longer break times, and the freedom to organize a union without interference.

Although Charles spends her days helping people find affordable health care, she often avoids going to the doctor because she can’t afford it. She takes a natural supplement to manage her hypothyroidism instead of the more expensive medication her doctor prescribed. “I don’t really know how my body is doing,” she says.

After nine years with the company and two promotions, she makes $21 an hour, including bilingual pay, and her insurance deductible is $2,000. Her two children, who she supports as a single mother, receive health insurance through Medicaid, the government-subsidized plan for those on low incomes.

At a press conference today, Stacey Abrams and Claude Cummings Jr., president of the Communications Workers of America (CWA), spoke up in support of the striking workers. Cummings called out the Biden administration for failing to live up to its rhetoric about creating good jobs, while Abrams spoke of her family connections to Hattiesburg, Mississippi, where one of the call centers is located. Her father, who lived in Hattiesburg for years, went into septic shock a couple of years ago, and she was only able to save his life because of her access to top-notch health care. Call center workers, she said, “need to know that in the middle of a crisis, their question is not, ‘How am I going to pay for it?’ Their question should be, ‘How can I take care of those around me?’”

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On top of the stresses of medical bills, call center employees must put up with frustrated, irate, and at times abusive callers. “I’ve been called everything but my actual name,” says Christina Jimenez, a Maximus employee who handles support for Medicare recipients from her home office in Hattiesburg. Employees who let their upbeat, professional demeanor slip face the prospect of poor customer survey ratings and the discipline that entails.

All calls are recorded, and employees are tracked from the moment they punch in to the moment they leave, through a phone system that uses different codes to categorize their time. Jimenez and Charles both work from home and say they often have to rush back from the bathroom to avoid exceeding their six-minute window. For those who work on site, Charles says it can take several minutes to walk to and from the restroom, quickly chewing through their allotted time.

Maximus employs 10,000 call center workers at 12 sites across eight southern US states, providing support to multiple federal agencies, including the Centers for Medicare and Medicaid Services and the Centers for Disease Control, under a nine-year $6.6 billion contract. The CWA, which is helping organize the workers, says this workforce is predominantly comprised of Black and Latina women and alleges that racial and gender disparities exist between lower level workers and upper managers, who tend to be white men. Maximus has defended its diversity record, noting that it has passed all federal audits of its hiring and promotion practices.

After a series of strikes over the years failed to bring about significant change, the workers are training their sights on the Biden administration, which they see as more sympathetic than Maximus. Biden has expressed strong support for unions, and his administration launched the Good Jobs initiative last year in an effort to improve job quality nationwide. The president’s historic appearance on the United Auto Workers picket line this fall also fired up employees. They are demanding that the administration raise the minimum wage for federal contractors from $16.20 to $25 an hour, in line with the pay of direct government employees performing similar work; that the governement ensure access to affordable health care; and that it investigate racial disparities and employment practices at Maximus.

Christina Jimenez (right) stands with other call center workers on strike in Hattiesburg, Mississippi on November 1, 2022.Courtesy of CWA/Call Center Workers United

Workers have accused the company of unlawful union busting; their allegations include retaliatory layoffs and claims of bonuses being offered to those who come to work during a planned strike. The National Labor Relations Board issued a complaint against Maximus last year for interfering with workers’ rights after it called the police on employees distributing union literature. The company settled the complaint.

Maximus spokesperson Eileen Rivera says that the company “complies with union organizing and strike protections provided by the National Labor Relations Act” and that it is proud of the work it does on behalf of the Centers for Medicare and Medicaid Services. Rivera says that Maximus has increased compensation and reduced out-of-pocket health care expenses in the five years since it took over the CMS contract and cites the company’s employee engagement survey as evidence of employee satisfaction. She says the survey found that 77 percent of respondents who work in a call center would recommend Maximus as a great place to work.

Call centers frequently serve as proving grounds for algorithmic management tools that heavily surveil workers and automate away any periods of idleness. Maximus advertises a “Robotic Process Automation” bot that sits on employee workstations and claims to boost productivity by “enabling call center agents to more rapidly respond to callers without needing to pause for data to be manually handled.” Jimenez says she hops directly from one call to the next, with no breaks in between, and during open enrollment she sometimes has to work mandatory overtime.

Jimenez says that her calls are monitored by an AI tool that “tells on us” if it detects certain words or phrases. For instance, if the bot detects that she veers off script or a customer complains about a bad connection, it will report the complaint to her manager. “But they don’t pay for our internet,” she says.

Jimenez started working for Maximus in 2020 and makes $16.20, the minimum wage for federal contractors. Until recently, she was the sole provider for her three young children, and she says she’s skipped meals so that they could eat. She has polycystic ovarian syndrome and is supposed to visit the doctor every couple months for checkups, but she hasn’t gone in over a year because she can’t afford the $113 cost per visit on top of the $400 monthly premiums she pays for her family. She says her son went almost a whole school year without getting glasses he needed because she couldn’t afford them.

Last month, Senator Bernie Sanders sent a letter to Maximus CEO Bruce Caswell criticizing the company for the allegations of union busting and for paying a median salary of $39,000 despite making $311 million in profits and spending $96 million in stock buybacks and $6.3 million in CEO compensation in 2022. He called on the company to improve its wages and working conditions.

The workers who walked out today see their fight as part of a broader struggle that’s been waged by US auto workers, UPS drivers, Hollywood writers and actors, and others to protect living wage jobs from corporate greed. While Jimenez and Charles find helping people navigate their health plans rewarding, they say that work needs to be valued. “If you can’t respect us, we’re going to show you how to respect us,” Jimenez says.