Affordable Care Act – Librarians’ Dilemma

On August 1 I posted Some Libraries Resist Assisting ObamaCare – Some Librarians Express Concerns and echoed some librarians concerns about essentially “promoting” ObamaCare to library users. Recently, I participated in a teleconference call hosted by HHS addressing issues and questions about implementation of the Affordable Care Act.

This third in a series of three calls is intended specifically for stakeholders in Utah where there will be a Federally Facilitated Marketplace for the individual market and a State Based Marketplace for the Small Business Health Options Program (SHOP). The call will feature HHS and CMS Denver Regional Office officials and an Avenue H official followed by time for Q&A. Speakers are:
• Doyle Forrestal, Acting Regional Director, U.S. Department of Health and Human Services
• Jeff Hinson, Regional Administrator, Centers for Medicare & Medicaid Services (CMS)
• Patty Conner, Executive Director, Avenue H
Questions about the event? Contact

The first 30 minutes was a “canned” presentation literally read from scripts (you can always tell) about a lot of government acronyms that describe the many layers of bureaucracy that will bring this program to the public, while protecting your private medical information, containing lots of declarations of privacy protection, safeguards against fraud, etc., as well as a progress report on Centers for Medicare & Medicaid Services (CMS) Region 8 being ready for the October 1 deadline to go live. Once a listener gets over the $68 Million in federal grants to 51 community-based organizations in 11 states to train an unknown number of “navigators” to help people apply for healthcare, some of what was outlined seemed good – especially the requirement for Certified Application Counselors to be certified through training, be bonded like company treasurers and accountants, and licensed by a state’s department of insurance. It all generally sounded like a good thing, assuming that one can believe everything they are told by the government. [NOTE: Training for Navigators, Certified Application Counselors, and Agents and Brokers will be web-based.]

During the second 30 minutes devoted to Q&A, I was able to ask a question. In a few words I asked what they saw as the role of librarians in “promoting” this federal program. Of course I prefaced my question by assuming they all knew about the President’s video presentation at ALA, other agencies promotion of libraries becoming partners in advocating the program, etc. The answer I got, in a nutshell, mostly from Ms. Forrestal, was that libraries and librarians were not expected to be “navigators” or counselors to help people fill out online applications for healthcare, but, as I suggested, they simple provide access to information like they have always done with federal income tax forms. OK, after that I was fairly satisfied.

However, the caller immediately after me was a guy who was at that moment conducting training for a county library system in my state. He thanked me for the segue and told listeners that the librarians he was training were very enthused and interested in becoming Certified Application Counselors – the people who have to be trained, bonded and certified. My reaction was not one I care to share publicly.

My reaction to librarians who embrace this “service” on such a personal level is that they must be wearing blinders to forget what libraries and librarians have been doing for the past 3-4 years – HELPING MILLIONS OF LIBRARY USERS FIND JOBS.

Remember the economic downturn that put so many people and companies out of business that unemployment became the number one issue in America? Remember the gut-wrenching library closings of 2009, 10 and 11 because the local economy was so bad? Remember the ALA and PLA and every library organization extoling the value of the local library BECAUSE IT WAS THE MOST VITAL RESOURCE HELPING PEOPLE FIND JOBS?

Are you not listening to the impact that the Affordable Care Act is and will have on businesses and jobs? Are you not aware that labor unions are no longer supporting the Act? Are you not aware that normal healthcare insurance costs are already rising? Are you not aware that Congress is debating not funding the program because it does more harm than good to the economy? Are you not aware that employers are cutting employee hours even further to get below the 29 hour level so they don’t have to provide healthcare benefits that will bankrupt their business? Are those of you who are currently working less than 40 hours a week in your library prepared to work less than 30 hours a week because your school district, city, county, state, or university can’t afford the outrageous cost of healthcare?

Do librarians not understand the dilemma they are now being forced into? First we “do more with less” and help millions of our neighbors try to find employment. AWESOME!

Now we’re being asked to become “Champions for Coverage” (yes, I had not yet mentioned that advertising hooraaraa incentive for libraries) and to again be good public servants – regardless of the impact. Before librarians jump on this latest “public good” bandwagon, I strongly encourage them to research the impact of this program, rather than simply keep the blinders on and follow the parade down the new path toward more joblessness.

Remember that the “service” to jobless library users was not a government program. It was something that libraries understood was in the best interest of all concerned. Libraries were not asked to endorse or promote a government “program.” Being asked to endorse the Affordable Care Act is not in the best interest of libraries, or librarians. We are not government pawns to be sacrificed for some greater good – especially when there is no clearly identifiable “good” in it. I still agree with commentor StephenK who commented on LISNews blog, “Alas I don’t see this ending well.”


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6 responses to “Affordable Care Act – Librarians’ Dilemma

  1. AMEN!!! I must agree that those who are excited about this role, are folks that have forgotten how difficult and frustrating it can be for patrons who are technologically challenged. We just don’t have the staff to walk someone step by step through any process – from registering for food stamps to filing unemployment. It’s just enough for our patrons to feel hung out to dry. I feel we are being set up for frustration.

    • Thank you, that’s a whole other aspect of the issue that I didn’t even touch on.
      What’s really frustrating to me is that librarians who are rushing to embrace this new fabricated role make all librarians appear desperate to find “any” role. Libraries have not yet met the challenges of being a 21st Century library and all that encompasses, and now they are grasping at some new transient reason for being “needed.”

  2. Robert L. Pinnock

    Somewhat agree with your concept of the role of libraries.
    But you state your list of rhetorical questions (grievances) against ACA as if they were factual rather than Fox News / AM Talk radio talking points. Let’s take those points one by one:
    1) The impact on employers and jobs: The CBO has indicated that health insurance premiums overall for small business should be up to 4% lower; since implementation has not yet begun, it is premature to claim and adverse effect.
    2) Labor union support – it is ironic that that labor union opinions, normally scored by the right, are now embraced when convenient. Some unions oppose parts of the plan that attempts to control costs by taxing “cadillac” health plans. Any other time, you’d probably be cheering to cut any Union benefits.
    3) Normal healthcare costs are already rising – this is true, health care costs have been rising at a rapid pace for the last 20 years – that’s a primary reason for ACA. More than 1/6 of our economy is now devoted to health care spending. Health premiums have risen more than 80% over the last decade. Since 2003, employees now pay 89% more for health care. A recent Kaiser report shows that health care cost growth has actually lowered this year, probably because of a lackluster economic recovery. And the ACA hasn’t even begun.
    4) Congress is debating not funding the program – Well, the teabaggers are not debating: they have voted 40 times to defund it. No alternatives, no other solutions to these rising healthcare costs, just obstruction.
    5) Employers cutting back hours because of ACA – Well, perhaps some are, but 90% of jobs created since March 2010 have been fulltime. And there is not trend in the stats to show that the number of employees under 30 hours a week are becoming a bigger percentage of the workforce. Yes there are Fox News anecdotes, but no trend.
    6) The Outrageous cost of Healthcare? Did you just wake up to this? That, and an effort to bring health insurance to a large pool of poor folks is the reason for ACA. The Tea Partiers have an ideology, but no other solution.

    • Thanks for sharing your political views Robert, but I was actually trying to keep politics out of this conversation. It’s about the role of librarians, not the merits or lack thereof, of the law. And thanks for proving my point, because I would never accuse librarians who rush to embrace a law that “the people” can only find out what’s in it after it’s passed as demonstrating their political bias.

  3. Michael Golrick

    You say you want to leave politics out of it, but *to me* it feels like you have a strong opinion.

    Let’s face it, the ACA is about to be implemented. Even if libraries do nothing, we are going to have people come in and need help.

    I agree that some of what we are being asked to do is above and beyond, like with the tax forms. What bugs me the most is that, unlike with the tax forms, they are not providing paper forms. As a front line librarian, I can tell you that there are many, many people who have difficulty using computers, and there are even more who are resentful of being forced to use them for daily life.

    So, I agree with this part of what you are saying: Librarians need to be extremely careful and cautious about how much more they agree to do, and how much they personally get involved in the lives of our users. As an organization, Libraries need to be careful of what we agree to provide for other agencies.

    I do not agree that by knowing about the system that we become “Champions for Coverage.” I think we owe that to our users to be informed. (We have not become “Champions of the Income Tax” simply by providing forms.)

    Oh, and for a discussion about “the gut-wrenching library closings of 2009, 10 and 11”, I suggest you check out the work of Walt Crawford who has done empirical research on library closings. There may be reduced hours, but the number of closings is small. Threatened reductions and closings are reported widely, but often are not as severe as initially threatened.

    • Thanks Michael. I agree totally that librarians are often asked to do much more than “provide access” to information because many library users need more assistance than that, and who better to ask for “advice” than your friendly, knowledgeable librarian. Where is the proper place to hold the line on such “service”? The “Champions for Coverage” incentive that the federal government is dangling like a carrot is intended to get organizations’ support, and give them recognition for their efforts. Maybe that label will be more of a deterrent to some, since it’s a voluntary thing.
      BTW: Hopefully, we all read the comments from officials at Public Library of Charlotte & Mecklenburg County cutting $17M from their 2010-11 budget, and numerous other large library systems, where the budget cuts caused hundreds of library worker layoffs. I think those folks, both the ones who had to do the cutting as well as the ones who lost their jobs, felt it was gut-wrenching.

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