At the Frontlines of Policy Implementation: Contrasting Experiences of Affordable Care Act Navigators

This qualitative study addresses the experiences of paid professionals and volunteers who worked through nonprofit human service organizations to help people obtain health insurance in the first wave of open enrollment for the Patient Protection and Affordable Care Act (ACA). Focusing on the state of Alabama, we compare and contrast the experiences of ACA navigators in different settings: (1) established nonprofits that received federal contracts to provide navigation services, and (2) a new nonprofit started specifically to help people sign up for ACA coverage. Findings contribute to the policy implementation literature by illuminating how policy implementation in different nonprofit settings can result in varying experiences of personal and political transformation. Findings contribute to the policy feedback literature by illustrating the potential for policy feedback effects on frontline workers. The study also illustrates again that human services nonprofits can create organizational conditions to promote empathy, excitement, and dedication at the frontlines.