Based on an IMLS study estimating that 37% of library users access computers in the library and seek help from librarians for health-related questions, PCLS anticipated that a significant percentage of the 95,000 uninsured residents in Pierce County would seek assistance from the public library to understand both the impact of the Affordable Care Act (ACA) and the enrollment process. Strategies incorporated the needs of both in library and digital customers seeking ACA information. PCLS reaches residents with services and facilities in 1800 square miles of rural and unincorporated Pierce County. The Tacoma Pierce County Health Department, the lead organization for ACA enrollment efforts in Pierce County, and the eight other organizations it had enlisted to help are located in a small area inside the Tacoma City limits on the northern border of Pierce County. Approximately 80% of uninsured County residents live outside of this area. Recent transit cuts have eliminated significant service to areas more than 10 miles beyond Tacoma. PCLS offered physical locations for trained experts to meet with clients, ability to reach potential customers in its service area, resources and assistance, and helped expand access to information and help for persons seeking information or enrolling in ACA, especially those who have limited access to transportation.

The Library coordinated group information sessions, scheduled times with in-person assisters, hosted three “Super Saturday” events where in-person assisters were made available, and held two bilingual workshops. PCLS bilingual staff connected customers with limited or no English to bilingual navigators. A web page was created to provide resources and links to serve online customers. As a result, customers had convenient places to learn about health insurance and get help with the enrollment process. A critical part of this service was ensuring that the ACA services and programs were meaningful to customers. PCLS staff were trained to assist customers in understanding the marketplace and to begin the enrollment process. PCLS developed partnerships to make experts available in-branch. In-person assisters (IPAs) were schedule in local library branches to provide customers the opportunity to receive the same level of service they would have experienced at the agency or organization in Tacoma. This allowed regions of the county to receive service it didn’t readily have available and, in turn, in-person assisters were able to connect with customers they would not otherwise have met. Customers were deeply satisfied with having help available locally and in knowing their questions were answered by experts. The Tacoma-Pierce County Health Department’s goal was 8,050 enrollments, but far exceeded this by registering 16,376 community members for insurance by the end of open enrollment. Critical to this success was bringing together the unique and varied skills of its partners, and being available to people in their own communities.

PCLS offered multiple ways for the community to connect with ACA resources, which resulted in 495 individuals receiving resources and information during open enrollment, and 211 enrolling and 40 IPAs trained to assist individuals.

PCLS efforts resulted in:

• Partnership with Tacoma Pierce County Health Department:
• Two library staff received IPA training to have in-house experts for the enrollment process.
• Participation in weekly partnering agency meetings.
• Participation in three county-wide “Super Saturday” events where IPAs were at designated locations for an entire day (79 people were enrolled at PCLS).

TPCHD’s goal was to enroll 8,050 individuals for health insurance but far exceeded this by enrolling 16,376 individuals. The Rand Corporation has selected Tacoma-Pierce County Health Department as one of seven public health organizations for a national study on highly effective models for collaborative partnerships.

• 205 people attending informational programs in 18 branches.
• Over 40 IPAs trained in three library-hosted training sessions.
• 211 individuals were enrolled by In-Person Assisters at seven branches on over 31 different dates.
• 4,287 page views of the online presence for library customers to access reliable information related to the ACA.
• Educated front-line library staff about the ACA and consumer health reference, and created an online space for staff to receive updates about the Washington Health Exchange and ACA to help provide exceptional service.
• Monitored ZeroDivide, ALA, and IMLS efforts to improve public libraries e-health skills and incorporated appropriate tools, training, and information.
• Joined National Network of Libraries of Medicine.