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1
Introduction
On March 23, 2010, President Obama signed into law the Patient
Protection and Affordable Care Act (PPACA, Public Law 111-148).1 The
PPACA was amended by the Health Care and Education Reconciliation
Act of 2010 (Public Law 111-152)2 on March 30, 2010, and the final ver-
sion is referred to as the Affordable Care Act (ACA). Implementation of
the Act, in concert with other major health policy initiatives of 2010, will
result in significant changes to the U.S. health care system. Among its
many provisions, the ACA will extend access to health care coverage to
millions of Americans who have been previously uninsured. Coverage
will be achieved through a variety of mechanisms including, for example,
expansion of Medicaid eligibility, and the establishment of state health
insurance exchanges. Many of the newly eligible individuals who should
benefit most from the ACA, however, are least prepared to realize those
benefits as a result of low health literacy.
Nearly 90 million adults in the United States have limited health lit -
eracy. While poor health literacy spans all demographics (sex, race, age,
income, education, ability/disability, national origin/primary language,
etc.), rates of low health literacy are disproportionately higher among
those with lower socioeconomic status, limited education, or limited Eng-
lish proficiency, as well as among the elderly and individuals with mental
1 Full text online at http://origin.www.gpo.gov:80/fdsys/pkg/PLAW-111publ148/pdf/
PLAW-111publ148.pdf. (accessed May 1, 2011).
2 Full text online at http://origin.www.gpo.gov:80/fdsys/pkg/PLAW-111publ152/pdf/
PLAW-111publ152.pdf (accessed May 1, 2011).
1
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2 HEALTH LITERACY IMPLICATIONS FOR HEALTH CARE REFORM
or physical disabilities. Studies have shown that there is a correlation
between low health literacy and poor health outcomes (Berkman et al.,
2004). People with poor health literacy are more likely to make errors with
their medication, less likely to complete medical treatments, more likely
to be hospitalized, and have trouble navigating the health care system
(IOM, 2004).
Many individuals with low health literacy will face significant chal-
lenges understanding what coverage they are eligible for under the ACA,
making informed choices about the best options for themselves and their
families, and completing the enrollment process. In addition to the need
to attend to the health literacy of individuals, it is recognized that health
literacy efforts must also address the demands and complexities of the
health care systems with which patients interact. The reality is that the
goals of the ACA cannot be achieved without addressing both types of
health literacy issues. While the ACA contains only very limited direct
mention of health literacy, there are numerous provisions where health
literacy could be included in broader efforts such as expanding coverage,
patient-centered care, or improving quality.
On November 10, 2010, the Institute of Medicine (IOM) Roundtable
on Health Literacy convened a workshop to explore potential opportu -
nities to advance health literacy in association with the implementation
of health care reform. The Roundtable on Health Literacy focuses on
building partnerships to advance the field of health literacy by translat -
ing research findings into practical strategies for implementation, and on
educating the public, press, and policymakers regarding issues of health
literacy. Roundtable workshops are designed to bring together leaders
from the federal government, foundations, health plans, associations, and
private companies to discuss challenges facing health literacy practice and
research, and to identify approaches to promote health literacy in both the
public and private sectors.
To facilitate discussion at this workshop, the IOM commissioned
the Center for Health Care Strategies to prepare a paper reviewing the
health literacy implications of the recently enacted ACA. Panelists were
provided the paper in advance, and came prepared to discuss the health
literacy-related opportunities and challenges that the various provisions
of the new law present.
Key findings of the commissioned review, Health Literacy Implications
of the Affordable Care Act, are presented by the authors in Chapter 2, fol-
lowed by remarks from Anand Parekh, Deputy Assistant Secretary for
Health, on why 2010 was a pivotal year for national action on health
literacy. Chapter 3 focuses on opportunities and challenges for individu -
als under the ACA, and Chapter 4 explores opportunities and challenges
for the organizations implementing the law. Finally, Chapter 5 presents
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3
INTRODUCTION
the workshop moderator’s reflections on the workshop, and a general
discussion on health literacy and the implementation of the ACA. The full
commissioned paper is available in the Appendix C.
Note that this workshop was organized by an independent planning
committee whose role was limited to developing the meeting agenda.
This summary has been prepared by a rapporteur as a factual account of
the discussion that took place at the workshop. All views presented in the
report are those of the individual workshop participants and should not
be construed as reflecting any group consensus.
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