Academic journal article Journal of Family and Consumer Sciences

What Extension Professionals Say about Teaching Health Insurance: Results from a Nationwide Survey

Academic journal article Journal of Family and Consumer Sciences

What Extension Professionals Say about Teaching Health Insurance: Results from a Nationwide Survey

Article excerpt

As the 100th anniversary of the Smith-Lever Act approached, Extension administrators identified health as a national priority issue for Extension programming. A task force of Extension leaders, identified by the Association of Public and Land Grant Universities' Experiment Station and Extension Committees on Organization and Policy (ECOP), was tasked with the goal of transforming the Cooperative Extension service to be a leader in health research and education. This task force was asked to both identify health priorities for the Cooperative Extension System (CES) health programming, and for outcome indicators for each priority. They also were asked to identify potential partners, who would be engaged in resource development, program implementation, and outcomes reporting.

Released in March 2014, the task force's report, Cooperative Extension's National Framework for Health and Wellness (Extension Committees on Organization and Policy [ECOP] 2014), identified six priority areas: health policy issues education; health policy; integrated nutrition, health, environment, and agricultural systems; chronic disease prevention and management; health insurance literacy; and, positive youth development for health. Action teams were appointed to address each of the six priority areas. Figure 1 illustrates the framework for how Cooperative Extension will address health through multiple levels of influence.

This paper reports the results from a survey conducted by the health insurance literacy action team mentioned above, which sought to assess the current state of health insurance literacy efforts within the CES.


Health insurance literacy is the degree to which individuals have the knowledge, ability, and confidence to (a) find, use, and evaluate information on health insurance plans; (b) choose the plan that best meets their needs and those of their family based on their financial situation and health status; and, (c) use the health insurance once purchased (Quincy, 2012). Health insurance literacy incorporates not only health and financial literacy, but also numeracy and document literacy. Research shows that many consumers have limited ability to apply both informational and mathematical skills to making health insurance decisions (Kenney, Karpman, & Long, 2013; Long, Shartzer, & Politi, 2014; Politi et al., 2014). Finding, using, and choosing health insurance can be difficult for consumers with limited health insurance literacy (Tennyson, 2011).

The need for health insurance literacy has been well-documented. Researchers have found a general lack of health insurance knowledge and much confusion among consumers (Kenney et al., 2013; Loewenstein et al., 2012; Long et al., 2014; Norton, Hamel, & Brodie, 2014; Paez & Mallery, 2014; Politi et al., 2014). Only one-fifth (20%) of consumers were able to calculate out-ofpocket costs (Paez & Mallery, 2014). Also, low levels of health insurance literacy have been linked to a delay in health treatment, increased personal bankruptcies, and a lower overall perception of personal health (LaMontague, 2014; McCormack, Bann, Uhrig, Berkman, & Rudd, 2009; Morgan et al., 2008; Paez & Mallery, 2014).

Cooperative Extension is uniquely positioned to educate consumers and increase their health insurance literacy. Considered a unit of land-grant universities, and established by the SmithLever Act in 1914, Extension's mission is to translate knowledge and research generated at land-grant universities to increase the quality of life for individuals and families (National Institute of Food and Agriculture [NIFA], 2017). Cooperative Extension has an educational presence across the United States and has been educating individuals and families on ways to improve their health for more than 100 years.

When the Affordable Care Act was passed in 2010 in the U.S., segments of the CES were among the first to develop education programs to help consumers understand health insurance. …

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