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[February 10, 2014]
OBAMACARE AND THE PROPER ROLE OF PUBLIC LIBRARIES IN HEALTH LITERACY [Computers in Libraries]
(Computers in Libraries Via Acquire Media NewsEdge) Our role is not of healthcare practitioner, insurance agent, or liberal agenda propagandist. We must be advocates for literacy of all sorts.
I must admit, I was excited to hear that President Barack Obama called on public libraries to be involved in a consumer education campaign on healthcare reform. I did not attend the American Library Association's (ALA) Annual Conference in Chicago. I learned about the announcement on Facebook. Shortly after the 2013 conference, ALA's president Barbara Stripling stated that librarians already help people in finding information about citizenship, disaster relief, and patents, and "we expect libraries will receive many inquiries from the public about the Affordable Care Act [ACA]." The Institute of Museum and Library Services and the Centers for Medicare & Medicaid Services (CMS) ramped up to help public librarians learn about the ACA (aka "Obamacare"). The National Network of Libraries of Medicine (NN/LN), state libraries, and OCLC's WebJunction prepared libguides and scheduled webinars.
At the same time, those opposing the ACA took to the blogosphere. A bevy of comments on Hot Air (hotair.com), a leading conservative blog covering the Obama administration, indicated disapproval for librarian involvement in such a partisan piece of legislation. In the comments for the blog post, "Newest Foot Soldiers for ObamaCare: Librarians," one conservative librarian vowed not to "peddle a product that I vehemently disagree with." Library volunteers threatened to discontinue their support. And some posts challenged the whole concept of public libraries.
That was the summer of 2013. We all experienced the healthcare.gov rollout debacle in October. By November, I had to stop watching the train wreck to remind myself of why I was excited in the first place. I thought about my larger questions-those sparked by the idea that a president would extend an invitation to public librarians to become involved in healthcare reform. How do Americans currently view public libraries? How thoroughly should public librarians learn about information resources? Are public libraries appropriately positioned to support community health? I am the outreach librarian for a teaching hospital in western Massachusetts. My job is to help patients and their families find reliable health information to support their decision making. Additionally, I do reference work in Baystate Health's Consumer Health Library. I get out into the community to teach hands-on classes for internet searching and for the use of health information apps.
In addition to my work duties, I am on the executive board for the Massachusetts Library System, a state-supported collaborative project that provides advisory services, professional training, and resource sharing for all types of libraries in Massachusetts. I serve as the Healthy Communities leader for the NN/LM's New England region. I actively support the idea that Massachusetts public libraries should take an interest in leveraging our ability to improve the health of our communities. That is my bias. My passion is public libraries and community health.
This summer, I was, at first, excited. And then ... ? I wanted to know what was truly happening in public libraries with regard to the ACA, especially considering the lower than expected enrollment numbers. And to figure out where we go from here, I sent emails across the country.
"To be honest," says Bonnie Brzozowski, reference librarian at Corvallis-Benton County Public Library in Oregon, "we have very little happening here." Gretchen Scronce, a librarian at Charleston County Public Library in South Carolina, tells me, "I've had exactly one person ask me about the ACA." I posted an informal survey on the Massachusetts libraries listserv. "We have not received a single ACA question," an anonymous librarian replies.
Was Obama's invitation to public libraries a mistake? Is the ensuing fuss really just a tempest in a teapot? Let's take a look at my larger questions with regard to how the public views libraries, librarian training in information resources, and the role of libraries in community health.
Libraries as Access Points to Information In my informal survey of Massachusetts public librarians, I asked (rather sloppily) about libraries as access points for information. Only 10% of respondents state that they felt that their libraries were used primarily for internet access-with no need for a librarian. The majority of the 88 respondents indicate that Massachusetts public libraries are serving as access to both the internet and librarian assistance in equal measures. Patrons who come into the library only for computer access will navigate to their favorite websites, porn, or otherwise, without much assistance from librarians-unless they are experiencing technical difficulties. I have stories I could tell you, but you probably have stories of your own.
Those who do ask for help are the people who need very basic help-logging on, printing documents, and opening email attachments. Some patrons are overwhelmed by the information pulled up on a website and request assistance from the librarian.
People in need of services, such as FEMA (Federal Emergency Management Agency) after a natural disaster, approach the reference desk for assistance. The Information Policy & Access Center's (iPAC) 2013 survey, "Public Libraries & Digital Inclusion," states that 91.8% of surveyed libraries reported helping people understand government websites in 2011 and 2012. A whopping 82.7% of libraries reported informal, point-of-use instruction for any digital access need (up from 76.6% in 2009 through 2010). Our transition to digital communication is creating new demands on librarians.
Even with a librarian's help, problems are not always resolved. If the information cannot be found or if a website is misbehaving, librarians are adept at referral services. "We do a lot of referrals when it comes to government forms," says Brzozowski. "Worksource Oregon helps people sign up for unemployment [and] the Small Business Center walks people through some of the complex processes involved with starting a business." Most librarians are very cautious about going too far with assistance. In my survey, librarians emphatically state that they never assist with completing forms of any sort. Finding forms is commonplace. Librarians sometimes stretch to the point of briefly scanning a form to understand why the patron is getting an error message after submitting. Brzozowski mentions that a bilingual librarian at Corvallis-Benton County Public Library often helps with interpreting immigration and other government forms for Spanish-speaking patrons. Several survey respondents speak of the need to help set up an email account so that a patron could proceed with the initial task.
Just for the record, the request for help with government forms is not limited to left-leaning states. Scronce points out that, in the very red South Carolina, unemployment claimants are directed by the state to the public library as connection points for online access. "We help people every day with unemployment questions," says Scronce, "so I feel confident that if our customers were enrolling [with healthcare.gov], they'd be asking us for assistance." Helping Patrons Quickly and Efficiently Public librarians familiarize themselves with information resources in order to perform their jobs. Their training runs the gamut from webinar updates for library-purchased databases to repeated exposure to highly requested material. Despite the common refrain, "Who needs a library when it's all on the internet?" thirty percent of American households do not use the internet at home, according to a 2012 report from the National Telecommunications and Information Agency (NITA). iPAC's previously mentioned survey asserts that public libraries are community anchors in a digital world. Trained librarians are helping to ensure digital inclusiveness of all communities in the 21st century.
Scronce identifies what most librarians hope to gain through information resource training, wanting "mostly to be able to direct customers to the appropriate resource for their needs, and be familiar enough with the process and the website so we can help them find what they need quickly and efficiently." Scronce went on to say that the South Carolina State Library has hosted webinars and provides ACA information on its website. "At Charleston County Public Library, resources such as those offered by the State Library and WebJunction were promoted in staff forums. The library developed guidelines for providing assistance: direct customers to the ACA web address and phone number, provide basic computer assistance and extend computer time as necessary, and avoid giving advice or interpreting insurance plan options," she says.
Does the process, at any point, take on the quality of peddling products? Despite my passion for librarian involvement, the campaign for Champions of Coverage made me a little uneasy as I viewed it through a broader lens. CMS suggests 10 ways for organizations to promote the Health Insurance Marketplace. These suggestions included a spectrum of choices. At the highest "promotion" end, champions share widgets for the marketplace on their websites and post success stories through social media sites. Clearly, this promotion effort goes beyond being a resource for government forms.
Libraries are likely to reflect the inclination of their communities. Barbara Stripling's statement was very clear that the decision "about how libraries will respond to inquiries about the ACA will be made by local libraries. As always, libraries do not promote specific programs or points of view, but provide the public with balanced, unbiased access to information." In Corvallis, says Brzozowski, the public library is planning "a Cover Oregon display [and] we expect to have a community partner set up appointments to help people sign up." Its website does not showcase widgets or triumph stories. The concern about librarians pushing liberal agendas may be a tempest in a teapot. The previously mentioned iPAC survey asserts that the United States has more than 17,000 library buildings and bookmobiles. As of mid-November, fewer than 100 library districts were listed as Champions of Coverage on marketplace.cms.gov.
In terms of understanding the basics of signing up for (rather than promoting) health insurance coverage, how prepared do librarians feel? What have libraries done to educate the public? In my survey of Massachusetts librarians, I asked if individual libraries or state agencies had provided any online resources or learning opportunities about the ACA. This was a trick question. I was involved personally in pushing out information to public librarians and co-taught two classes with Michelle Eberle from NN/LM's New England region. Raymond Hurd, regional administrator for the Centers for Medicare & Medicaid for New York and Boston, took part in our recorded webinar. I knew that the Massachusetts Library System, thanks to Anna Popp, had a libguide to the ACA.
Of the 88 librarians who responded to my survey, 57% say that they had received links and training. The remainder was split between expressing that nothing was provided or that they did not know what their libraries or the state had provided. That was discouraging. I realize that some respondents may have expressed that their own library is not providing links and training for the public. Again, 111 confess that my survey was sloppy. One librarian expressed the hesitancy that plagued the healthcare.gov rollout: "A [training] webinar was available but it did not seem like a good idea to plunge ahead with ACA assistance as long as the signup website was such a mess." Libraries and Literacies A tiny piece of paper tacked above my desk says, "Librarians are Advocates for Literacy, Intellectual Freedom, Privacy, Fair Use and Preservation of Cultural Heritage." This advocacy role responds to changes in technology and in the economic growth-or decline-of our communities. With regard to literacy, librarians advocate for early literacy, English as a second language, digital literacy, health literacy, financial literacy, and now insurance literacy. The aspiration to support literacy is as old as our nation. Thomas Jefferson himself stated, "No one more sincerely wishes the spread of information among mankind than I do, and none has greater confidence in its effect towards supporting free & good government." As the outreach librarian for a teaching hospital, I hope to spread health information into the communities that we serve. I teach people how to find information so that they may take better care of themselves and their loved ones. Good healthcare depends on preventative measures. Without preventative healthcare, people are unaware of the progress of chronic disease. According to a 2005 report to the U.S. surgeon general, almost 1 in 2 adults has at least one chronic illness. The very heart of healthcare reform is increasing access to preventative healthcare.
Our country depends on health insurance as the entry ticket to preventative healthcare. The U.S. Census Bureau identifies that those living at or below 138% poverty are the least likely to have health insurance. These people are not the poorest of our poor. These are people who work as cashiers in grocery stores, cooks in fast food restaurants, and clerks at department stores. The ACA is designed to assist all people in accessing health insurance that will cover the following 10 essential health benefits: 1. Ambulatory patient services 2. Emergency services 3. Hospitalization 4. Maternity and newborn care 5. Mental health and substance abuse services 6. Prescription drugs 7. Rehabilitative services 8. Laboratory services 9. Preventative services and chronic disease management 10. Pediatric services, including oral and vision care The Health Insurance Marketplace is not a single-payer insurance plan. Its healthcare.gov website is a portal for purchasing private insurance. The marketplace does screen applicants to see if they qualify for Medicare, Medicaid, or subsidies to help them pay for private insurance. For those who do not qualify for any government assistance, the marketplace explains how to purchase private insurance that best fits the needs of the person or family.
Understanding insurance is no simple task. The language of insurance challenges most of us: premiums, deductibles, copays, co-insurance, out-of-pocket limits, and in-network and out-of-network providers. In my sloppy survey, I asked the question, "How relevant would it be for your job to learn about the Affordable Care Act, Medicare/Medicaid, or health insurance in general?" Many librarians stick to the concept of learning the basics of how to help patrons with the website. They want to avoid the role of insurance advisor.
In contrast, 94.5% answered enthusiastically to my suggestion that libraries become involved in community partnerships to address health issues. Many stated that their hbraries offered space for blood pressure screenings, flu vaccine clinics, exercise classes, and lectures on health topics. Partnerships exist with pubhc health departments, senior centers, and local hospitals. Some hbrarians bemoaned the lack of space, claiming that they would love to be able be involved in community health. Several librarians felt that targeting healthrelated topics to the aging population would be successful. One hbrarian expressed a desire to address the issues of teen pregnancy in her community.
Role in the Community As the year closes, and I write this, I am attempting to disentangle from the political firestorm in order to identify the role of libraries and librarians in community health. Dozens of public hbrarians tell me that they view their role as responding to any information request and guiding patrons to the appropriate resource or making referrals to the appropriate agency. Some hbrarians are hesitant to assist patrons with signing up on healthcare.gov. The politics are hot and the website has been wonky. According to the hbrarians I spoke with, the demand for assistance has been low. "I am curious to see if activity picks up as the deadline approaches," says Scronce. If demand for assistance does pick up, pubhc hbrarians will be able to review recorded webinars and information links on the ACA (see sidebar). Despite all of the hoopla surrounding the ACA, many pubhc hbrarians are excited about getting involved in community health initiatives. Our role is not of healthcare practitioner, insurance agent, or liberal agenda propagandist. We must be advocates for literacy of all sorts.
VIEW FROM THE RIGHT "Newest Foot Soldiers for ObamaCare: Librarians" June 29, 2013, by ALLAHPUNDIT The more ubiquitous the Internet and e-readers get, the less use people have for libraries and thus the further away from their core function libraries will drift. In theory they're still about book-lending but credit the feds for recognizing their growing role as places lower-income people can get online for free. Per Gallup's latest, fully 43 percent of the uninsured have no idea that they're now statutorily [sic] required by Hopenchange to seek coverage. If you're trying to reach the poor to let them know that they qualify for health insurance subsidies-or, rather, that they don't qualify-then this is a no-brainer. Coming soon, presumably: Deputizing the postal service, another institution that's being laid to waste by technology, to start selling policies door to door.
Comment: Remember this the next time you hear about your library struggling and in need of more funding in order to keep operating. Sounds to me like they have a lot of liberal time on their hands. Who still uses a library anyway? I have more information right here on my keyboard and immediately available and I do not need to waste time, gas and sneeze fr[om] all those dusty, stale crumbling books and view all the perverts on the free computers looking at porn.
Comment posted by j bo on July 1,2013, at 10:55 a.m.
MY SLOPPY OPEN-ENDED SURVEY QUESTIONS In your experience, would it be more accurate to say that library patrons view public libraries as sources of information or as access points to the internet? I guess I am trying to get at whether the librarian is asked for information literacy assistance or mostly for help getting online.
Do you routinely help patrons with government online forms (taxes, unemployment, etc.)? Find forms? Fill out forms? How relevant would it be for your job to learn about the Affordable Care Act, Medicare/ Medicaid, or health insurance in general? Has your library or state made efforts to provide online resources and learning opportunities about the ACA? In the "public health" world, there is a big push for community partnerships to address health issues. Do you see libraries as becoming more involved in community health? Some ideas include offering space for health screenings, community discussions of local health concerns, library displays of health information, etc. Are you already doing this? Resources to Help You Brush Up on the Affordable Care Act * Healthcare.gov website: healthcare.gov * WebJunction's Health Happens in Libraries: webjunction.org/explore-topics/ehealth/ webinars.html * U.S. Centers for Medicare & Medicaid Services' Health Insurance Marketplace's training materials: marketplace.cms.gov/training/get-training.html * MedlinePlus' health insurance topics page: nlm.nih.gov/medlineplus/healthinsurance.html REFERENCES ALA President Releases Statement on Libraries and the Affordable Care Act. American Library Association, July 12, 2013. ala.org/news/press-releases/ 2013/07/ala-president-releases-state ment-libraries-and-affordable-care-care-act.
Census.gov website: census.gov/did/www/ sahie/data/files/F03-SAHIE-2011-State-Un insured-by-IPR.jpg.
"Exploring the Digital Nation: America's Emerging Online Experience." National Telecommunications and Information Agency, 2012. ntia.doc.gov/files/ntia/publications/ exploring_the_digital_nation_-_americas_ emerging_online_experience.pdf.
Healthcare.gov website: healthcare.gov/ how-do-i-apply-for-marketplace-coverage.
Hot Air blog: hotair.com/archives/2013/06/ 29/newest-foot-soldiers-for-obamacare -librarians.
Malachowski, Margot. "Public Libraries & ACA." SurveyMonkey, last visited Dec. 4, 2013. surveymonkey.eom/s/GQD5Z7Q.
M. Malachowski, Margot. Personal communications, October/November 2013.
"Public Libraries and Digital Inclusion." The Information Policy & Access Center, Sept. 30, 2013. digitalinclusion.umd.edu/sites/defaull/ files/DigitallnclusionBrief_9-30-2013.pdf.
South Carolina Department of Employment and Workforce website: dew.sc.gov/about -service-locations.asp.
Centers for Medicare & Medicaid website: marketplace.cms.gov/help-us/champion.html.
Surgeon General website: surgeongeneral.gov/ initiatives/prevention/strategy/priorities.html.
The Jefferson Monticello website: monticello.org/site/jefferson/quotations -education.
Margot Malachowski (Margot.Mal firstname.lastname@example.org) is the outreach librarian for Baystate Health, a network of hospitals, physician practices, and community clinics serving western Massachusetts.
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