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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 PLAW-111publ148.pdf. (accessed May 1, 2011). 2 Full text online at 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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