Roundtable member Yolanda Partida applauded the involvement of health plans in promoting health literacy, and in particular, the focus on developing standards for user-friendly language and improving methods to communicate complex health insurance information. Once this information is available in an understandable format in English, it will be easier to translate information across languages and culture.

Ruth Parker, roundtable member, discussed the potential importance of the Plain Language Act of 2010 to the operation of the exchanges, particularly the enrollment processes. Parker said she was impressed by how large a segment of the population will be engaged with the health insurance exchanges. She suggested that the enrollment process will improve, in part, because of the magnitude of the audience that needs to be reached. It may be that individuals will liken the process of enrolling in a health plan to the national tax system. There is a federal process to file taxes, and there is a state process. People are aware that there are multiple forms and that some of these forms are relevant to some and not to others. When filing taxes, personal assistance is available through accountants. Navigators will be available to assist those needing help in making insurance choices. Exchanges need to be demystified and their functions understood by using clear, standardized language. Isham added that the analogy to the tax system should stop short of the frustrations that many experience. Instead, the model of the tax system is appropriate in the use of easy-to-use forms with customization where necessary.

Martha Gragg, roundtable member, noted that the awareness of health literacy principles has increased in the last few years, especially among health plans. She suggested that employers, as critical determinants of employee insurance options, need to become more aware of issues related to health literacy.

Linda Harris, roundtable member, expressed concern that some states might be overwhelmed in trying to develop a health insurance exchange. Effort will be needed to assure clear communication that incorporates considerations of health literacy, cultural competency, and language diversity. States will need to create mechanisms to inform and enroll hard-to-reach populations that are currently not insured, she said. Community-based organizations will have to be engaged to bring such individuals into the system. Harris said that a repository of the literature and materials on health literacy relevant to the exchanges would be potentially very useful.

Will Ross, roundtable member, noted that enrollment in some of the exchanges has been lower than expected and that it is the responsibility of the exchanges and health plans to improve their relationship with consumers. Market research has shown that consumers are overwhelmed and fearful of making health insurance choices, he said. The onus is on the exchanges to improve the experience of choosing and then enrolling

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