Updated November 1, 2022 at 7:06 PM ET

Workers who handle calls about Medicare and Affordable Care Act health plans walked off the job in Louisiana, Mississippi, Kentucky and Virginia today, demanding better pay and a less stressful workload.

The workers are employed by Maximus, a federal contractor. They are asking for a pay raise to $25 per hour and more breaks between calls. The call center workers answer about 15 calls per day, averaging about half an hour each. On busy days like today, which is the first day of open enrollment for the Affordable Care Act, workers said they can take up to 20 calls.

Maximus had operating income of $408 million in fiscal 2021, and has 34,000 employees globally. Sylvia Walker, a customer service representative who participated in the walkout in Bogalusa, Louisiana, said she feels she is not paid enough for how demanding her job is.

"You can wear so many hats on any given call. There could be a crisis," she said, after which call workers are expected to file a report then turn to the next caller. "We are a counselor, we're the doctor, we are the lawyers. We are everything to these people."

Two years ago, she said one woman on the other end of the phone expressed an intention to commit suicide.

"We're not equipped for that," said Walker. Maximus said employees are trained to use scripts if a caller discusses the possibility of suicide.

Walker, who is 68, said she has been working for the company for nine years and has received pay bumps twice. She currently makes just over $17 per hour and works 40 hours per week. The Bogalusa resident is eligible for Medicare, but she said she can't afford to retire yet.

In a statement, Maximus said it "welcomes the opportunity to work directly with our employees and discuss and hopefully resolve their concerns. Over the past several years, Maximus has improved pay and compensation, reduced employees' out-of-pocket health care expenses and improved work processes and safety." The company also said it did not anticipate any disruption in services.

Call center workers, who organized with support from labor union Communications Workers of America, delivered their demands to company leadership five days before the walkout. Employees at Maximus do not belong to a union, even though many have been organizing for months. The extent of worker participation in the walkout is under dispute. CWA said that more than 400 workers went on strike at four call centers. Maximus said that fewer than 200 employees participated in the job action.

"I want to see a union before I leave this place," said Walker.

Camille Wade, 31, who has worked at the Bogalusa location for eight years, said she has experienced racism during calls.

A majority of Maximus workers across U.S. locations are women and people of color, according to a release by the Communications Workers of America.

"Sometimes if they're able to tell and pick up by my voice that I am a Black woman, they'll automatically want to go above me," said Wade, who now works for Maximus' internal support group after she was promoted from a customer service representative.

But she said Maximus offers no strategies for preventing abusive or dismissive calls. "If we don't put up with the abuse, we get fired."

Workers in Bogalusa and two other Maximus locations went on strike earlier this year claiming poor working conditions and inadequate protection against COVID-19. Several days later, CWA filed a complaint to the National Labor Relations Board against Maximus for intimidating workers who walked out.

Maximus says employees can request bathroom breaks at any time and can take two 15 minute breaks in addition to their half hour lunch break.

But for some workers, like Walker, it's not enough. "You can get someone who talks you down or looks down at you as if you're less than," she said. "Dignity is something that is important."

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Correction

.An earlier version of this story said the call center workers handle calls about Medicare and Medicaid. They provide customer service about Medicare and Affordable Care Act health plans.