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.