1

Introduction

Since the passage of the Patient Protection and Affordable Care Act (ACA), health care reform has created major changes in the U.S. health care system. The ACA has brought millions of people into the system who had no previous access. Many of these newly enrolled individuals have had limited experience navigating the complex and complicated U.S. health system. Furthermore, they may be unfamiliar with health insurance language, concepts, and information. Finally, given the results of the 1992, 2006, and 2012 surveys of adult literacy skills, it is likely that many of those newly enrolled adults may have limited numeracy and health literacy (which has been described as the alignment of system demands and complexities with individual skills and abilities). This means that many of the applicants will face difficulties using the provided texts and undertaking the needed calculations as they sort through options and make decisions.

In his introductory remarks to the workshop, Bernard Rosof, chief executive officer of the Quality in Healthcare Advisory Group and professor of medicine at Hofstra Northwell School of Medicine, noted that the Roundtable on Health Literacy has previously engaged in a number of activities related to health care reform. A 2010 workshop explored the challenges and opportunities for health literacy within the context of health care reform (IOM, 2011). A subsequent workshop, held in 2012, focused on how health-literate practices could facilitate state health exchange communication (IOM, 2012).

Members of the roundtable have also produced three discussion papers on the topic of health care reform. The first presented basic information that can be used to help people understand their health insurance options

(Patel et al., 2013b). “This paper is a resource for those who will be helping consumers make important and informed decisions for patient navigation, community organizations, employers, media educators, and any individual or any organization working to improve understanding of the options for health insurance,” explained Rosof. The second discussion paper focused on the importance of amplifying the patient voice and of communicating with different types of communities in meaningful and understandable ways (Patel et al., 2013a). The third paper addressed four questions: What are my options for health insurance? How do I get it? How do I use it? What will it cost? (Wu et al., 2013). The roundtable also commissioned a project to identify strategies that were successful at enrolling individuals from hard-to-reach populations (Parker et al., 2014).

Revisiting the topic of health literacy in the context of health care reform, the Roundtable on Health Literacy formed an ad hoc committee¹ charged with planning and conducting a 1-day public workshop to examine health insurance through the lens of health literacy, focusing on literacy related barriers to information and coverage as well as on possible solutions (see Box 1-1). The workshop was held in Washington, DC, on July 21, 2016.

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¹ The planning committee’s role was limited to planning the workshop, and the workshop summary was prepared by the workshop rapporteur as a factual summary of what occurred at the workshop. Statements, recommendations, and opinions expressed are those of individual presenters and participants and have not been endorsed or verified by the National Academies of Sciences, Engineering, and Medicine, and they should not be construed as reflecting any group consensus.

ORGANIZATION OF THE PROCEEDINGS

The workshop (see Appendix A for the agenda) was organized by an independent planning committee in accordance with the procedures of the National Academies of Sciences, Engineering, and Medicine. The planning committee’s members were Judith Hibbard, Catina O’Leary, Kavita Patel, Lynn Quincy, and Michael Villaire. This publication summarizes the workshop’s presentations and discussions, and it highlights important lessons, practical strategies, and potential needs and opportunities for applying the principles of health literacy to the task of helping individuals enroll in health insurance and make use of the benefits to which they are then entitled. Chapter 2 provides an overview of some of the lessons learned after 3 years of experience in enrolling individuals through state and federal health insurance marketplaces. Chapter 3 recaps a moderated discussion that provided different perspectives on the challenges faced in helping the uninsured to get and use health insurance. Chapter 4 discusses some of the ways in which health literacy and health insurance literacy contribute to solving the challenges raised during the preceding moderated discussion. Chapter 5 includes highlights on a second moderated discussion that covered a number of topics, including how to support navigators, comparing plan information, human-centered design practices in billing and literacy, attracting the “young invincibles,” and the role of libraries in health insurance literacy. Chapter 6 recounts a third moderated discussion in which the panelists gave their thoughts on the day’s presentations, and Chapter 7 provides the roundtable members’ reflections on the day.

In accordance with the policies of the National Academies, the workshop did not attempt to establish any conclusions or recommendations about needs and future directions, focusing instead on issues identified by the speakers and workshop participants. In addition, the organizing committee’s role was limited to planning the workshop. The workshop proceedings were prepared by workshop rapporteur Joe Alper as a factual summary of what occurred at the workshop.

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