will differ by their associated premium cost, benefit coverage, and out-of-pocket expenses (e.g., deductibles, co-payments). It may be particularly difficult for individuals with poor literacy and numeracy skills to find an insurance plan that meets their needs when faced with many insurance options. Nearly half of all American adults—90 million people—have inadequate health literacy to navigate the health care system (IOM, 2004). Health literacy is “the degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions” (Ratzan and Parker, 2000).

Many of the newly eligible health insurance consumers will be individuals of low health literacy, some speakers of English and others more comfortable using languages other than English. Health insurance terms such as “deductible,” “co-insurance,” and “out-of-pocket limits” are difficult to communicate even to those with moderate-to-high levels of health literacy and so health exchanges will face challenges as they attempt to communicate to the broader community. In addition to having to convey some of these basic, and yet complex, principles of insurance, state exchanges will be attempting to adapt to the many changes to enrollment and eligibility brought about by ACA. While these challenges may seem daunting, there are important lessons to be learned from a number of existing programs and research endeavors.

The Institute of Medicine (IOM) convened the Roundtable on Health Literacy to address issues raised in its report Health Literacy: A Prescription to End Confusion (IOM, 2004). The roundtable brings 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. The roundtable’s focus is on building partnerships to move the field of health literacy forward by translating research findings into practical strategies for implementation. The roundtable also serves to educate the public, press, and policy makers regarding issues related to health literacy.

The roundtable sponsors workshops for members and the public to discuss approaches to resolve key challenges. Reports from workshops held by the roundtable include the following:

•  Standardizing Medication Labels: Confusing Patients Less: Workshop Summary (2008)

•  Health Literacy, eHealth, and Communication: Putting the Consumer First: Workshop Summary (2009)

•  Toward Health Equity and Patient-Centeredness: Integrating Health Literacy, Disparities Reduction, and Quality Improvement: Workshop Summary (2009)



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