From Enrollment to Outcomes: A View from Public Libraries

From Enrollment to Outcomes: A View from Public Libraries

Health Happens in Libraries

According to the Centers for Medicare & Medicaid Services, more than 6 million Americans have enrolled in health care coverage since the open enrollment period for the federal and state-based health insurance Marketplaces began on October 1st, 2013, under the Affordable Care Act (ACA). Many Marketplaces (also known as exchanges) experienced a surge of enrollments in December, including an average of 15,000 enrollments per day by mid-December at the state exchange in California. 

Libraries Ready to Respond

As noted recently by Ken Brecher, president of the Library Foundation of Los Angeles, technology has facilitated a “golden age” for libraries, an era of increased partnerships with the philanthropic sector and a renewed and expanded opportunity for libraries to support community needs through innovative public programming. Far from merely administering a warehouse of information, libraries across the country are increasingly adopting a proactive role in partnership with other anchor institutions to host and manage a vast, public curriculum, including youth and adult education initiatives, workforce development, community enterprise and business incubation, and community health and wellness programs.

Since July 2013, ZeroDivide and OCLC’s WebJunction have been working with the support of the Institute of Museum and Library Services (IMLS) to connect state and public libraries with resources to support their communities during the ACA rollout. To date, we have conducted interviews with a number of state and public library representatives, all of whom shared diverse perspectives on the opportunities and challenges of providing health information in a library context. Given the recent increase in enrollments around the country, we wanted to share some of our early learnings about how some libraries are responding to the public information opportunities associated with the ACA. Feel free to visit our team’s Health Happens in Libraries project site for individual library stories and other resources.

Some emerging observations

Building on existing public programming is a necessary component of delivering health information in libraries

Many public libraries have long—and in many instances without increases in funding—developed expertise in serving the public for a variety of local needs. Whether it’s preparing workshops for income tax-filing deadlines, holding after-school homework sessions for neighboring schools or helping people experiencing homelessness to access community resources, libraries have adapted to meet evolving community needs. Libraries have been able to use these experiences and adapt some of their strategies already designed for literacy programs, housing and job development programming, and hands-on IT training for the challenges of ACA health insurance adoption to address patron information needs in recent months.

Rural libraries face tough resource and connectivity challenges

One of the most striking pieces of feedback to date has been the urban/rural resource divide highlighted within rural library systems. Generally, urban public library networks have been able to access the resources and partnerships necessary to conduct in-person events for patrons in the areas of greatest population density. Low internet connectivity and scarce staff resources, however, have challenged the efforts of some rural libraries in meeting this emerging public information need. In some areas, county health departments have been able to support the work of rural libraries, and connections with local community health stakeholders bolster library capacity in small or rural areas. This is exemplified in our recent case study of Oklahoma’s Miami Public library. Other innovative strategies for reaching patrons in rural areas have been sending mobile laptop labs for ACA-focused information sessions and disseminating template meeting agendas and invitation samples to all public libraries.

Partnerships are key to sparking enrollments in any implementation environment

Successful eHealth and ACA-related library event programming has largely rested upon connections made with local universities, medical libraries, community-based organizations and state Navigator/Assistor organizations. At times, state and public libraries have faced challenges during the last several months in establishing and maintaining interagency partnerships, given the rapidly changing information landscape around Marketplace eligibility, the application process and enrollment deadlines. Those that do, however, reap the benefits of establishing, expanding and enriching communities of practice within and across their institutions. Their efforts provide access additional community resources, allow for public program continuity, and germinate cross-pollinating program strategies and tools, further integrating community safety nets. 

ZeroDivide and WebJunction have worked to capture and share examples of the innovative partnership strategies, community engagement activities, and responsive resources that state and public libraries are providing. These resources are freely available to review and share, and also create an opportunity to learn more about how to get involved in connecting libraries and communities with health information.

ZeroDivide and WebJunction will host a webinar on the role of library partnerships in facilitating ACA patron engagement on March 27th at 11 a.m. PST. Stay tuned to WebJunction’s Health Happens in Libraries webinar page to register to join us in our discussion of best practices in building inter-organizational library partnerships to deliver inventive public programming. 


ACA enrollment, digital literacy, 21st century libraries, libraries