While I am not an expert on the Affordable Care Act, as a clinical psychologist who conducts research on patient-centered care and health literacy, I am concerned about how millions will find their way through the maze of information without the basic understanding they need to make good choices.
On the HealthCare.gov website, some of the communication tools used are commonly recommended by those of us working in the field of health literacy. There are videos on how to use the Marketplace and other videos portraying personal stories about selecting health insurance. Some have gotten hundreds of thousands of views so far.
Perhaps most important for those whose low literacy precludes effectively navigating a website, or for those whose primary language is something other than English or Spanish, there is the 24/7 telephone helpline as well as lists of local organizations that can provide personal assistance with applications (there are more than 500 in my area). And recently a tip sheet was released to help those with new insurance.
But will all this be enough?
In my clinical role at the Robert H. Lurie Comprehensive Cancer Center of Northwestern University, I provide psychological services to patients who have cancer—a population that faces large healthcare costs and is concerned about insurance coverage for pre-existing conditions. With enrollment deadlines looming, our center gave a presentation for patients wondering how the ACA would affect them.
But some patients with limited health literacy need much more assistance. Our coordinator of supportive oncology education has spent up to five hours helping just one patient apply for insurance through the Marketplace. She has needed to explain basics like premiums and deductibles, as well as how to compare insurance options. She has walked patients through checking to make sure their current doctors will be covered under new plans. Notably, despite having proficient health literacy and training, the coordinator has herself sought assistance to confirm the finer details. Clearly, these are not easy tasks.
These experiences echo the findings of a recent study from the Urban Institute indicating that a majority of those most likely to use the Marketplace are not confident in how well they understand even rudimentary health insurance terms.
How much the U.S. government spends on healthcare gets a lot of attention. But our below-average literacy among developed countries is more of a dirty, not-so-little secret.
Three literacy-relevant policy initiatives released in 2010 were eclipsed by the signing of the ACA into law that year. President Obama signed the Plain Writing Act, requiring that communication to the public by federal agencies be understandable. Healthy People 2020 included increasing health literacy among its national objectives and HHS Secretary Kathleen Sebelius launched the National Action Plan to Improve Health Literacy.