Health Literacy Implications of the Affordable Care Act
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Health Literacy Until Now
In its Healthy People 2010 aims statement, the Department of Health and Human Services (HHS)
adopted the definition from the National Library of Medicine, declaring health literacy to be an
important national health priority. Healthy People 2010 broadened this definition to note that health
literacy is not just the problem of the individual, but also a by-product of system-level contributions.
4
Acknowledging the salience of this issue, HHS Secretary Kathleen Sebelius made official a federal
commitment to health literacy by releasing in May 2010 the National Action Plan to Improve Health
Literacy.
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The plan lays out seven goals that emphasize the importance of creating health and safety
information that is accurate, accessible and actionable. It addresses payers, the media, government
agencies, health care professionals and others, recognizing the multi-sector effort that will be required to
effectively tackle this oft-ignored, national problem.
The U.S. health care system, with its myriad public and private programs, institutions, services, products,
and information, poses a significant challenge to those seeking access to affordable, quality health care.
Understanding the complexities of insurance eligibility, therapeutic guidance, medical technology,
prescription medication, disease management, prevention, and lifestyle modification are difficult for any
consumer, let alone one with compromised levels of literacy or numeracy (or quantitative literacy). An
individual seeking to participate successfully in the health system requires a constellation of skills —
reading, writing, basic mathematical calculations, speaking, listening, networking, and rhetoric — the
totality of which defines health literacy.
However, national data suggest that only 12 percent of adults have proficient health literacy.
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While low
health literacy is found across all demographic groups, it disproportionately affects non-white racial and
ethnic groups; the elderly; individuals with lower socioeconomic status and education; people with
physical and mental disabilities; those with low English proficiency (LEP); and non-native speakers of
English.
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Low health literacy is associated with reduced use of preventive services and management of
chronic conditions, and higher mortality.
8
It also leads to medication errors, misdiagnosis due to poor
communication between providers and patients, low rates of guidance and treatment compliance,
hospital readmissions, unnecessary emergency room visits, longer hospital stays, fragmented access to
care, and poor responsiveness to public health emergencies.
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Accordingly, low health literacy has been
estimated to cost the U.S. economy between $106 billion and $236 billion annually.
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The consequences of low health literacy have been recognized by federal agencies such as the Agency for
Healthcare Research and Quality (AHRQ), the Centers for Disease Control and Prevention (CDC), the
Food and Drug Administration (FDA), the Office of the Surgeon General, and the National Institutes of
Health (NIH), as well as by private organizations such as America’s Health Insurance Plans, the
American College of Physicians, the American Medical Association, The Joint Commission on
Accreditation, Kaiser Permanente, and Pfizer. These entities and many others are promoting awareness,
creating program initiatives, funding targeted research, setting readability standards, working with e-
health and social media platforms, and providing tools and resources for measurement and quality
4
R. Rudd. Objective 11-2. Improvement of Health Literacy. In: Communicating Health: Priorities and Strategies for Progress.
Office of Disease Prevention and Health Promotion, U.S. Department of Health and Human Services, Washington DC, 2003.
5
U.S. Department of Health and Human Services, Office of Disease Prevention and Health Promotion. National Action Plan to
Improve Health Literacy. Washington DC, 2010.
6
National Center for Education Statistics, U.S. Department of Education. “2003 National Assessment of Adult Literacy (NAAL).”
Available at http://nces.ed.gov/naal/.
7
L. Neilsen-Bohlman, A.M. Panzer, and D.A. Kindig. Health Literacy: A Prescription to End Confusion. National Academies Press.
Washington DC, 2004.
8
N.D. Berkman, et al. Literacy and Health Outcomes. Agency for Healthcare Research and Quality (AHRQ). Rockville, MD, 2004.
9
Neilsen-Bohlman et al, op cit; Berkman et al, op cit., Vernon et al, op cit.
10
Vernon, et al., op cit.