Palm Beach County, Florida is one of the largest counties east of the Mississippi River. The county population is over 1.3 million representing a nearly 17% increase from the 2000 census (US Census 2010). Based on the Palm Beach County Community Health Assessment, June 2012, the percentage of uninsured people in Palm Beach County (26%) exceeds the percentage of uninsured people in the state of Florida (21%).

Of the nearly 279,000 uninsured people in Palm Beach County:

• 15.3% of children ages 0-18 in Palm Beach County were uninsured (12.7% for Florida)
• 30.2% of adults age 18-64 in Palm Beach County were uninsured (29.9% for Florida)
• 33.8% of African American residents of Palm Beach County were uninsured (26.2% for Florida)
• 38% of Hispanic or Latino residents of Palm Beach County were uninsured (34.3% for Florida)

The number of individuals and families living below poverty in Palm Beach County rose an alarming 23% from 9.9% to 12.2% (US Census 2010) This past July, the federal government enlisted the help of 17,000 public libraries across the US to help provide information to their patrons about new health insurance options under the ACA. With the dire situation in Palm Beach County, the Library's Consumer Health Information Service (CHIS) strategized to maximize libraries' efforts in our community with ACA education, application assistance, and enrollment.

The Consumer Health Information Service (CHIS) organized an ACA Library Community Partnership of libraries, social service agencies, navigator and certified assister agencies, and political representatives with the goal of working together to take full advantage of community resources. CHIS staff also cultivated a close relationship with the Health Council of Southeast Florida (HCSEF), Palm Beach County's lead ACA agency supported by Department of Health & Human Services, meeting regularly with members of their Enrollment Palm Beach County group. Training of local librarians was launched to support ACA efforts. CHIS librarians created a pathfinder and added a section to the CHIS web site so system librarians and county residents would have at-their-fingertips, authoritative ACA resources. CHIS then presented these resources at two Reference Workshops designed to train branch librarians. HCSEF staff was also invited by CHIS to present at these library professional staff workshops. ACA educational programming for the public began in September 2013 at branch location with Palm Beach County League of Woman Voters classes. At the same time, Enroll America, a grassroots collaborative organization, began handing out literature and speaking to people about the new healthcare marketplace outside Library branch locations. This was followed by an intense effort by six licensed navigator agencies organized by CHIS staff at Library locations to meet the burgeoning demand for enrollment assistance before the deadline for coverage. The well-publicized technical glitches made outreach and assistance even more critical. One hour appointments often stretched longer due to system problems, with individuals often following up subsequent appointments. Pleased with this initial success, CHIS continued to provide ACA outreach through the April 2014 extended deadline.

CHIS ACA initial outreach efforts prior to the deadline for Jan 1, 2014 coverage including educational programming, application assistance, and enrollment reached 265 people. Outreach efforts from January through the April 15, 2014 extended deadline included 13 more enrollment events at 7 PBC branch locations. There were an additional 309 people assisted at these events. CHIS partnered with local stakeholders and people of influence in our community who share our passion for improving access to health insurance. There were several 'lessons learned' after our initial outreach efforts. Coordinating the navigators for enrollment events by ourselves sometimes proved near impossible. Scheduling appointments for initial appointments and the responsibility to reschedule cancelled appointments presented special problems for Reference staff. For the second round of Library enrollment events, CHIS partnered with special ACA Outreach Coordinators. The Outreach Coordinators set their own appointments. They themselves were licensed navigators, so they were able to step in, as needed. The PBC Library System's relationship with community stakeholders continues. There are upcoming plans to meet with the HCSEF and Enroll America staff. Plans to discuss a new embedded-type service is underway.