Limited Literacy, Numeracy Hurts Those the ACA Is Meant to Help

The Affordable Care Act expanded healthcare coverage to many low-income Americans, but this same demographic has a low health literacy that makes it difficult for them to navigate program eligibility systems, according to a study from The Urban Institute.

The report is part of a series drawing on the results from the quarterly Health Reform Monitoring Survey (HRMS), supported by The Urban Institute and other foundations, such as the Robert Wood Johnson Foundation.

“Though the ACA has expanded the coverage options available to many nonelderly adults, obtaining and using that coverage is likely challenging for many adults,” authors Sharon K. Long, Adele Shartzer, and Mary Politi wrote.

Those 80 million adults who have low health literacy will likely have poorer health outcomes, according to previous research.¹ In their report, the authors used data from the June 2014 HRMS to describe literacy and numeracy among adults between the ages of 18 and 64 years.

Both literacy and numeracy tend to be lower for uninsured adults with family income below 400% of the federal poverty line (FPL). A fifth of this group of individuals rated both their literacy and numeracy as less than very good compared with just 9.7% of all adults.

“Gaps in literacy and numeracy among the uninsured will likely make navigating the health care system difficult, as indicated by the past experiences of insured adults in choosing a health plan,” the authors wrote.

Nearly half of insured adults with family income below 400% of FPL reported difficult finding information to support their plan enrollment decision. However, it is important to note that even insured adults with strong literacy and numeracy had a difficult time finding information on health plans when trying to enroll.

“…in the short term there is a need for carriers and those creating plan choice tools to strive to better support consumer choice, particularly for those with limited numeracy and literacy,” the authors concluded.

1. Berkman, ND, Sheridan SL, Donahue KE, Halpern DJ, Crotty K. 2011. Low health literacy and health outcomes: an updated systematic review. Ann Intern Med. 155(2):97-107.