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Health Reform 2.0: Improving Health Literacy of Older Americans

The Affordable Care Act (ACA) increases access to health insurance coverage, establishes a minimum benefit package, makes coverage more affordable, and eliminates most cost sharing for recommended preventive services. Now it’s time to empower consumers to take advantage of these improvements. One way to achieve this goal is to increase basic health literacy.


What is health literacy?
Health literacy is the capacity to obtain, process and understand basic health information and services in order to make appropriate health decisions.

Why does health literacy matter?
About 9 of 10 Americans struggle to access, understand and act on health information.
According to the National Action Plan to Improve Health Literacy , the lack of health literacy is a major public health problem that costs the U.S. economy between $106 billion and $236 billion annually . There is also a strong correlation between low health literacy and health disparities.

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Those most at risk include older adults, people with limited education, people of color and those with limited English proficiency.

Health literacy is particularly important for older adults.
Limited health literacy is associated with a variety of difficulties:

  • Making wise insurance coverage decisions — including when it is in one’s best interest to change plans or providers. Experience with Medicare Part D tells us that older adults do not make wise insurance coverage choices even when it is in their financial best interest.
  • Navigating the health care system, including filling out complex forms, locating providers and services, and filing appeals. Using health insurance appropriately is the key to good care and cost savings.
  • Sharing personal information — such as health history — with providers. The ability to communicate effectively with providers improves patient outcomes and helps prevent medical errors.
  • Engaging in self-care, including chronic disease management. Four out of 5 older adults suffer from at least one chronic condition.
  • Taking medications correctly. Older adults take more prescription drugs than any other segment of the population.


Limited health literacy is also associated with less use of preventive services, increased hospitalizations, higher health costs and higher mortality rates among older adults.

What can be done to improve health literacy?
Improving health literacy, especially among older adults, has the potential to save lives and dollars. It will also help to reduce health disparities. The ACA has several
provisions that directly acknowledge the need for greater attention to health literacy, as well as many others that do so indirectly.

However, the law does not provide strong policy levers or explicit funding to improve consumer health literacy. Now is the time to focus more attention and resources on this important public health issue.

Photo: ShutterWorx/iStock

Lynda Flowers is a senior strategic policy adviser specializing in Medicaid issues, health disparities, public health and health care quality.

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