Working Within the System

Critical thought and passion — that’s the combination that fills Graciela Guzmán ’11 with Grinnellian pride. As an enrollment specialist at a community health center on the northwest side of Chicago, Graciela enrolls people in healthcare plans and educates them about the Affordable Care Act, also known as Obamacare.

She started sharing her frustrations and her triumphs on her blog. It takes the form of visceral posts that demonstrate a depth of emotion you might not expect from a seemingly dry government procedure. Graciela says in a post from Jan. 17, “I write because really similarly to Harry Potter’s pensieve, sometimes you need somewhere to temporarily place a memory so you do not feel its weight but can still remember its immediacy and rawness.”

The enrollment form has questions about addiction, rehab, and domestic abuse, and so many of the enrollees have not had health insurance that it effectively compels them to tell their life stories. In Graciela’s experience, the reason her team is so successful is because its members communicate emotionally with their clients; they don’t compartmentalize. With a supply kit consisting of tissues, coffee, crayons, and coloring books, Graciela and her team are always aware of the human side of the Affordable Care Act.

The Chicago community Graciela works in has been historically uninsured. Roughly half of her clients are immigrants, and her office operates in English, Spanish, and Polish. Many of the people Graciela helped enroll didn’t have an email address before this process. Some had no reliable way for her to get in touch with them. This led her to do everything in her power to complete enrollments in one sitting and to begin believing in the law of emotional physics, which states that if Graciela’s team thinks about someone hard enough, “that’s the day they walk in to seek our aid. We bump into them on the streets, on the train, in the halls of our office, but somehow, the universe lines up.”

The healthcare enrollment website famously malfunctioned for its first month, but some functions — such as the enrollment process for immigrants — are still experiencing major issues. These persistent issues led to Graciela’s creation of a flowchart that takes into account the issues present in the marketplace process and allows other navigators to work within the imperfect enrollment system. “The reality of my community didn’t fit the ideal implementation of the policy,” says Graciela. Other organizations have adopted this chart and taken tips from her blog.

After the flurry of enrollments prior to the deadline, Graciela is turning her attention to post-enrollment issues. “There are days I can’t sleep, thinking about what post-enrollment life is like,” she says.

Graciela and her four teammates have touched 11,000 people through enrollment and education efforts so far. But enrollment is just the beginning. In some cases, health insurance doesn’t change a person’s circumstances as much as some would hope, and there’s still a lot of work to do, but Graciela takes it all in stride.  “What we have been doing until now has been the hard part. We’re about to get to the fun part,” she says.