How Functional Illiteracy Could Doom Obamacare
Policy + Politics

How Functional Illiteracy Could Doom Obamacare

iStockphoto/The Fiscal Times

The troubles for Obamacare continue to mount. The White House has delayed the employer mandate. Those implementing the program said some computer exchanges are not expected to be ready in time. According to the GAO, the IRS, which will enforce the mandate, is not ready. It might be impossible to confirm someone’s eligibility. Employers are already looking for ways around it.

All of these problems are technical in nature. The underlying and perhaps most pressing concern is also the most difficult to solve: Much of the nation is simply health care illiterate and unable to understand the complex health choices the Obama administration is expected to offer starting Oct. 1.

According to the CIA Fact Book, although 99 percent of Americans over the age of 15 can read, 20 percent are functionally illiterate.  Those 20 percent are often among America’s poorest and most disadvantaged—the very group the Obamacare is designed to serve.  

But many can’t read contracts, fill out job applications properly, and understand newspaper articles or other documents.  At the top of the problem—reading and understanding complex health care options.

A 2003 study by the Health and Human Services Department found that only 12 percent of Americans were healthcare literate. Some 77 million Americans were found to have basic of below basic health care literacy. Just 53 percent of Americans were found to have an intermediate understanding of health care, modestly defined as being able to make informed medical choices and follow instructions on drug labels.

The HHS study also found that only six percent of those without health insurance were proficient in health care. This means that the very people that Obama must enroll have very little idea of what they’ll be signing up for.

These people will have to receive a crash course on how the modern American health system works. They’ll need to learn what deductibles and co-pays are. They’ll have to understand prescription drug coverage, and how networks of doctor’s interact. They’ll also have to be convinced that it’s better to pony up hundreds of dollars for insurance and a tax break down the line than to roll the dice and hope they don’t get sick.

““It’s a complex product. Often times you find there’s a specific set of benefits to compliment certain situations,” said David Smith, director of payer services at Leavitt Partners, a Utah-based consultancy that’s helping to implement the program. “But to find that takes wading through several plans to 100 plans.”

In an effort to educate people, the Obama administration is training a fleet of experts to help people make decisions. HHS just committed another $67 million to its Navigator program, which trains guides for enrollees. It’s also created an in-person assistor program to give guidance as people sign up .

“Navigators will be among the many resources available to help consumers understand their coverage options in the marketplace,” HHS Secretary Kathleen Sebelius said last week. “A network of volunteers on the ground in every state — health care providers, business leaders, faith leaders, community groups, advocates, and local elected officials — can help spread the word and encourage their neighbors to get enrolled.” 

Smith said that his group had also been conducting focus groups to determine how to best educate people. They rounded up consumers who will be eligible for Obamacare to determine needs and how best to reach out to potential enrollees.

In poor areas, he said Navigators would be reaching out to people through social institutions – “Everyone in Mississippi said churches and hair salons,” he said – as well as knocking on doors to encourage sign up. Enroll America is also expected to continue its work through the fall and winter.

The White House has already failed to win some big partners. They asked the National Football League, which will be in full swing when enrollment opens, for assistance, but were denied. It has also reached out to the National Basketball Association for enrollment help, although the league has yet to commit.

However, Smith admits that enrolling people, not improving health literacy, is the top priority. Without hitting its enrollment figures, Obamacare would ultimately fail.

“The administration's objective right now has to be able to hit an enrollment number that’s defensible enough that it’s working. The tertiary objective is educating people," he said. "The longer term goal is to increase health care literacy."