In a recent study published in the journal Health Affairs, the Center for Health Policy Research at UCLA conducted telephone surveys of 35,033 adults in five languages (English, Spanish, Korean, Vietnamese, and various dialects of Chinese), trying to quantify “whether low health literacy is associated with lack of health insurance above and beyond other related factors, such as employment, the availability of employment-based insurance, race or ethnicity, and poverty” (from the abstract). Participants were categorized as having low health literacy (HL) if found instructions for prescription medications or other health information as “somewhat difficult” or “very difficult” to understand. Those who found information and prescription instructions “very easy” or “somewhat easy” to understand were rated as having adequate HL.
Among participants with low HL, 28.8% self-reported as being uninsured, compared to 16% of people with adequate HL. For those respondents who reported being employed full time, ” those with low HL were less likely to have been offered employer-based health insurance than those with adequate HL (19.9 percent versus 11.4 percent).” And while participants with low HL were just as likely to be employed full-time as those with adequate HL, they were less likely to have been offered health insurance by their employer.
This study has implications for federal, state and local public policy, such as the implementation of the Affordable Care Act (ACA). Using the results as an estimate of HL levels in the U.S. population as a whole, about ten million of the thirty-two million people who will now have access to medical care under ACA will have low or poor HL, and probably many more than that. How will we implement the ACA in ways that will accommodate persons with:
- Low HL
- Inadequate computer and information literacy skills (navigating insurance exchange websites, understanding online forms, weighing pros and cons and trade-offs, etc.)
- English as their second language
- Cognitive and physical disabilities
This also has enormous implications for libraries, especially public libraries. At a time when budgets are being frozen or slashed, and branches are being closed, libraries will be hard-pressed to meet the resulting increase in demand for computer and Internet access. Library staff will be asked to help patrons navigate the myriad choices being offered by these insurance exchanges with little or no additional training. And if a librarian helps a patron successfully navigate this selection process, could the library be sued if something goes awry with insurance, medical care, etc?
While the concept of insurance exchanges seems like a good idea, without adequate preparation and support, it may not succeed, and in a short time opponents of health insurance reform will renew their calls to “repeal Obamacare” as it is currently mis-labeled. To help people successfully access this yet-to-be created system, why not:
- Involve librarians in the planning and organization of the insurance exchanges themselves
- Provide additional funding to state libraries and the National Network of Libraries of Medicine to train staff at public libraries on how to assist patrons through this process.
- Provide additional funding for computers and high-speed Internet access.
Librarians already have too much on their plate, so some things may need to be set aside as a result. But we will cope while doing our best to serve our patrons.
How else should libraries prepare for this next challenge? What have you, our fellow librarians, learned from other endeavors that would assist us in preparing? Tell us!