Health Literacy: The Affordable Care Act Ups the Ante This fall, the enrollment period for state-based health in- surance began. By the end of 2014, more than 30,000,000þ new patients may be enrolled in health plans in the United States, under provisions of the Affordable Care Act (ACA). We are concerned about the lack of patient preparedness with regard to health literacy and medical science, 2 inter- related areas. 1,2 There has been a lack of medical science courses in US K-12 public schools from as far back as anyone can remember. 3 This can be traced back to a destructive ripple effect emanating from the 1910 Flexner Report, which produced a much needed reorganization of medical educa- tion, its intended outcome, but had negative consequences as well. 4 A half century later, the Flexner Report’s negative impacts were manifested by the disappearance of human medical science courses from US college general studies tracks. Today, the majority of US college students lack access to courses on medical science, contributing to the low level of health literacy. PATIENT PREPAREDNESS FOR THE AFFORDABLE CARE ACT Health literacy was defined in the 2004 US National Academy of Sciences’ Institute of Medicine Health Literacy monograph as “the degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions.” 5 According to an American Medical Association report, poor health literacy is a stronger predictor of a per- son’s health than age, income, employment status, education level, and race. 6 We have concerns with the ACA’s dependency on the health literacy and medical science components of personal preparedness. First, the level of health literacy is low by any standard. 2 Second, the scopes of official health liter- acy definitions need broadening. 5 Standards should be strengthened with greater specifics based on common dis- ease entities, for example, cancer, cardiovascular disease, and diabetes. TOWARD A K-12 MEDICAL SCIENCE/HEALTH LITERACY CORE COMPETENCY Sadly, it turns out that US national policy makers do not expect US high school graduates to know much about most common diseases at any time soon. They seem oblivious to the obvious link between health literacy and medical sci- ence, a carryover from the Flexner era. 3,4 In contrast, we think that every K-12 student should take medical science classes in preparation for their own future decision-making as ACA beneficiaries. That is incentive enough. By providing such medical science courses in local schools, we recently found that middle school students are at the right stage in their adolescent development to handle the coursework, at a time when they are less inter- ested in “doctoring” and more interested in the science, a desirable combination. We smiled when middle school students voted ‘Medical Science best elective course of the year’. 7 SUMMING IT UP Our point is that kids like to learn about diseases and should be encouraged to do so in primary and secondary schools. This would be their first step in preparedness training for shared responsibility between patients and their doctors, sometime down the road. This will require lifting a century-long partial moratorium on teaching about diseases in US K-12 public schools and colleges. The Flexner Report gets the “Century Award,” but nothing lasts forever! 4 Ronald S. Weinstein, MD, FCAP Anna R. Graham, MD, FCAP Kristine A. Erps Ana Maria Lopez, MD, MPH, FACP College of Medicine University of Arizona Tucson References 1. National Action Plan to Improve Health Literacy. Available at: http:// www.health.gov/communication/hlactionplan/pdf/Health_Literacy_Act ion_Plan.pdf. Accessed June 20, 2013. 2. Somers SA, Mahadevan R. Health Literacy Implications of the Afford- able Care Act. Available at: http://www.iom.edu/~/media/Files/Activity% Funding: None. Conflict of Interest: None. Authorship: All authors had access to the data and played a role in writing this manuscript. 0002-9343/$ -see front matter Ó 2013 Elsevier Inc. All rights reserved. http://dx.doi.org/10.1016/j.amjmed.2013.06.030 EDITORIAL