The 2010 Affordable Care Act (ACA) provides an opportunity for extension. Research shows that most Americans do not understand the law's provisions and are not comfortable making health insurance purchase decisions. By January 2014, nearly 30 million Americans will be making enrollment decisions; an estimated 180 million will be re-enrolling in health plans. Extension professionals have an opportunity to both educate and measure the impact of that education.

With passage of the ACA and the Supreme Court decision to uphold the law, our nation again tackled an issue affecting the well-being of our people — population health and access to and cost of care. Health affects the ability to perform well in school, on the job and as a productive, contributing member of society.

Monthly polls by the Kaiser Family Foundation find that most Americans remain confused about the law's 10 titles, key provisions and impact on their lives. And while websites from the foundation and the government provide information, people need help in understanding the provisions. And they need that help from a reliable source they can trust.

Public issues education

Extension, with its network of educators across the nation, is well-positioned to provide that education. We have a history of doing public issues education as a neutral party. Our own Journal of Extension contains articles that demonstrate this capacity.

In Maryland, in 2010, we held a statewide forum with local facilitators at sites connected through web technology to explore the ACA. Our focus was the ACA's impact on rural Maryland. Extension partnered with the University of Maryland School of Public Health, Hershel S. Horowitz Center for Health Literacy, Rural Maryland Council and Maryland Rural Health Association to conduct the workshop as part of a core health messaging project funded by a USDA Rural Health and Safety Grant. Ninety-six people attended. Our post-pre evaluation determined that understanding of the law increased, with that understanding still holding 6 months later. The data serve as an indicator that extension public issues education can make a difference.

Maryland is not alone in responding to health reform. Wisconsin extension also is doing programming. Likely still others are actively engaged in related public issues programming.

Preventive care education

The ACA makes preventive care a priority of the nation for the first time in our history. Prevention education is central to extension education in food and nutrition, safety, pesticide management and other programs. Extension can leverage the emphasis on prevention into programming opportunities to capture attention and interest in existing or new programming.

For example, in August 2012 most of the women's health provisions took effect. New private health plans are now required to cover a number of preventive health services. A premise of this provision is that women will now be able to make many preventive health decisions — not the government or the insurance companies. That premise is an opportunity for extension. We can educate women about the provision, what's covered and when they can begin to take advantage of the provision.

Health insurance literacy

Another ACA provision draws a great deal of attention — that of health insurance. Research shows that health insurance plans are complicated and difficult to understand and that the process of choosing is overwhelming. This applies both to those who have health insurance and those who will be purchasing insurance.

In November 2011, Consumers Union, the American Institutes for Research (AIR) and the University of Maryland held a Call-to-Action Roundtable that included three representatives from extension. The group produced the logic for, and a working definition of, the concept of health insurance literacy: Health insurance literacy measures the degree to which individuals have the knowledge, ability, and confidence to find and evaluate information about health plans, select the best plan for their own (or their family's) financial and health circumstances, and use the plan once enrolled.

Currently, AIR is doing the formative research to develop and test a measure of health insurance literacy. Such a measure can be used by extension as a pre- and post-test for impact assessment of health insurance education and by researchers to monitor change over time which could affect public policy.

Through timely education, extension can help to increase the knowledge, ability and confidence of health insurance consumers — including that of our own faculty and staff! With research colleagues, we can measure the impact of our programming using the standardized assessment of health insurance literacy and use for compiling impact across our system.

Bonnie Braun is a
professor and extension family policy specialist with the University of Maryland. For more information, contact her at