My title at my GHC placement is the ‘policy assistant.’ I applied to this position because I wanted to see what it would be like to affect change for a large number of people through policy changes, instead of having a smaller, though no less important, reach through on the ground community work. I really had no experience in policy at all before starting this job, and didn’t really know what to expect. I thought I might ease into it, reading some of the organization’s policies, possibly learning about policy creation, or something of that nature. Instead, I jumped into the deep end and read the Affordable Care Act. Yes, that’s right, the actual ACA. Ok, I won’t lie and say that I read the whole thing, but 800 pages out of 1100 is pretty good. When I tell anyone that they gasp that I must be an expert, and theoretically I should be, but that is so far from true.
In reading the ACA, I learned that reading and understanding are two VERY different things. I am convinced that people who write policy write it so that people can’t understand it. Policy is nearly impossible to read. For example, when describing what a state is required to do in regards to Essential Health Benefits, the policy states:
“STATE REQUIREMENT.—If a State requires, in addition to the essential health benefits required under section 1323(b)(3) (A), coverage of services described in subparagraph (B)(i) for enrollees of a community health insurance option offered in such State, the State shall assure that no funds flowing through or from the community health insurance option, and no other Federal funds, pay or defray the cost of providing coverage of services described in subparagraph (B)(i). The United States shall not bear the insurance risk for a State’s required coverage of services described in subparagraph (B)(i).”
… and that is just the beginning of a few pages that look exactly like that. There is no way to actually understand that! Many people are complaining about Health Care Reform because they don’t understand what is changing and how it is changing, which are very fair complaints to have. The problem is, I don’t believe many government officials completely understand it either, and if the people who created and passed the law don’t understand it, how can they possibly describe it to anyone else?
Granted, people who write and read policy and have been doing it for years have a much more expert eye than my own naive 23 year old first time reading policy eyes, but still, 1100 pages of text that references thousands of other laws/pages is not comprehensive to anyone.
Since reading the ACA I have written memos and briefs on various aspects of the act, and for every one of these, I have had to refer to secondary sources for clear facts, regardless of the fact that I have notes on the actual bill, as well as the bill itself. I also created a power point explaining some of the key aspects of the law that will affect my organization, and along with a supervisor, conducted a brief training for the office. I thought we had made the presentation approachable, but in the end, it turned out to still be high level, and complicated. There is no way to make it clear, even to those who are familiar with the rules of Medicaid/Medicare as they now stand. The scariest part for me was that another supervisor came up to me to compliment me on the training but mentioned that I hadn’t described how health insurance actually works, the basics of it, and I realized I still wasn’t really sure!
While working these last 6 months reading policy, I continue to believe that it is amazing being able to affect so many people using legislation. However, I also now understand why what needs to happen, so rarely is made a reality. It is because no one understands what is going on. In the non-profit world it is known that in order to effective in helping your community, you need to venture into the community. Input from the people in the society you are immersed in is necessary to not only be as efficient as possible, but simply to be productive and beneficial. There have been so many cases made about how giving large sums of money to various countries or towns who don’t know what to do with it, or to people who can’t handle it, can be seriously detrimental to everyone involved. Yet in American policy, if the people who work in policy and advocate for it don’t necessarily know what’s going on, how can anyone on the ground speak up about what they need and be heard?