Offering health insurance for reduced or zeroed-out premiums only works for those who have the basic reading, writing and arithmetic skills to navigate the system.
Unfortunately, uninsured adults with low incomes comprise the largest segment of society that lacks those basic skills. And being able to work with numbers turns out to be a much greater barrier than illiteracy.
The extent of that problem is outlined in a report by the Health Policy Center of the Urban Institute, with funding from the Robert Wood Johnson Foundation.
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The HPC reviewed input from a cross section of adults ages 18 to 64, and found that 54 percent of those without health insurance whose income was 400 percent below the poverty line rated themselves as struggling to some extent with "numeracy"—the ability to understand and work with numbers. Among all adults, the number was still high—37 percent.
When asked about literacy, 23 percent of those in the uninsured/low income group rated themselves as struggling, while 11 percent of the total survey group said they had problems with literacy.
When asked whether they had trouble with reading and crunching numbers, 20 percent of the low-income/uninsured respondents said they did, compared to 10 percent of all adults in the survey.
Add in the difficulties involved with trying to figure out the best health plan for oneself and/or one's family, and those individuals are often unable to cope.
The report said: "Even among insured adults with strong literacy and numeracy, finding information on health plans can be difficult when trying to enroll. … Navigating the changes in the health care system is challenging for many people, especially for adults with limited literacy and numeracy. For the uninsured adults targeted by the Marketplace and Medicaid expansion, the process of applying for coverage and selecting a health plan requires understanding insurance terms, calculating complicated costs, and assessing risk. The plan selection experiences of insured adults reported in the [survey] suggest that adults with limited literacy and numeracy often have difficulty finding information on health plans to support plan choice."
The center recommended that those setting up online and non-virtual systems for browsing and choosing health plans offer a variety of ways of explaining the options.
"As the next open enrollment period nears and individuals make enrollment and re-enrollment decisions, research suggests that providing information in many formats, such as numerical data, graphs, narratives, and text, enables people to absorb information in the best way for them. By providing access to decision-support tools, glossaries, and in-person assistance, as well as tailoring and presenting information in novel ways (such as interactive formats), Marketplace and Medicaid administrators as well as insurance carriers can help people make optimal enrollment decisions," the researchers said.
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Dan Cook
Dan Cook is a journalist and communications consultant based in Portland, OR. During his journalism career he has been a reporter and editor for a variety of media companies, including American Lawyer Media, BusinessWeek, Newhouse Newspapers, Knight-Ridder, Time Inc., and Reuters. He specializes in health care and insurance related coverage for BenefitsPRO.
