Sarah Carnes knows how utterly frustrating it can be to apply for insurance through a health-care exchange.
Carnes, a Master of Library and Information Science student living in the Boston area, wanted to throw her computer out the window while trying to navigate the process for her own coverage — and she’s familiar with insurance from her past careers. She couldn’t imagine having to navigate the system without that knowledge, or if she had a physical or mental disability.
“If I had had any issues, I would not be insured,” Carnes said. “If it was difficult for me with no impairment, how could it be fair for someone with an impairment?”
Carnes was able to address just such a problem in her Capstone project at the UW iSchool. She and fellow MLIS students Kathleen Sullivan and Johanna Jacobsen Kiciman created a resource guide that suggests ways to improve accessibility to the Washington Health Benefit Exchange website for many who need it most.
Carnes (at center in photo), Sullivan (left) and Jacobsen Kiciman had clear goals for their project. They wanted to do some good in the world. They wanted to serve a community that didn’t have equal access to information. And, to accomplish the first goals, they wanted to draw on their skills in reference librarianship and research.
The team found a project that met all those goals through a partnership with the Washington Health Benefit Exchange, the state arm of the Affordable Care Act. One in four Washington residents use the state’s Healthplanfinder website to obtain health insurance.
The guide they created supports the state’s efforts to ensure that people with disabilities won’t face barriers as they sign up for insurance. It gives the state the information it needs to create an electronic system that is easy for anyone to navigate — and that complies with federal regulations. The final product serves as a source for immediate improvements and a roadmap for future efforts.
“For us, it’s a social justice issue and an information equity issue,” Sullivan said. “Nearly 13 percent of people in Washington state report having some kind of a disability. That’s nearly a million people.”
The students broke the project into three main parts: Research, interviewing experts, and contacting other states and countries with health exchanges. For the research, the team saved the exchange the time-consuming process of collecting all the relevant regulations and research on accessibility. With their librarianship skills, they were able to quickly gather and curate the documents that would be most useful to the exchange.
The students also interviewed experts on the experience of users with disabilities, as well as advocacy organizations, and collected the information for the exchange. Finally, they reached out to other exchanges, both in the United States and Europe, to learn what methods and resources had been most valuable to them in efforts to ensure equal access to benefits.
“It has been so rewarding to talk to organizations that are doing this work,” Carnes said.
Creating accessible electronic information for the exchange is vital for several reasons. First, it’s the law — one that the Department of Justice has emphasized in recent years.
Second, some people who most need the exchange might also face the greatest barriers to access. And finally, making the site more accessible for those with impairments makes it easier for everyone to navigate the site.
The guide includes a checklist of features to ensure that the site is accessible. Among other features, they included advice on how to make the site easy to navigate for people who use screen readers or only use a keyboard, rather than a mouse. They also included advice on keeping language simple, which can be useful for users with dyslexia or other learning differences or for whom English is a second language.
The students’ final report has already been put to use. Joan Altman, the exchange’s associate director of legislative and external affairs, said information technology staff has been using the guide to improve its accessibility efforts.
“Some of the best practices identified by the students have been incorporated into an accessibility checklist that will be used by staff and vendors who work on system improvements,” Altman said.
The team’s work greatly sped up the state’s efforts on this project, which will lead to faster implementation of system improvements and policies to increase access for those who face potential barriers.
“The group was able to research and organize a vast amount of information in a compressed time frame,” Altman said.
She said the report will continue to be invaluable, and will even be used by other state health agencies, including the Health Care Authority and the Department of Social and Health Services.
The project has also drawn attention beyond the iSchool and the exchange. Learn Web Accessibility, an open access website, added the final report to a list of top resources. Other states have also asked to see the final report.
“It’s nice to see the project gaining traction, which we hope also amounts to improvements in accessibility for disabled users,” Jacobsen Kiciman said.
Sullivan appreciated the chance to put the skills she had learned in the iSchool to use, including a focus on equal access to information.
“The MLIS program has been fantastic at emphasizing that call to equity that is very much part of libraries and information services,” she said. “It opened my eyes to the large chunk of the population that is not getting equal access to information on the web.”
And while the team is done with its Capstone and the students are moving on, Sullivan emphasized that accessibility work must be ongoing, and so the team made the guide easy to edit as new tools or methods are created.
“It’s not like you make your tools work and then you are done,” she said. “It requires ongoing attention. The experts unanimously said that you really have to make sure that your culture is an accessible culture. The tools for accessibility are constantly evolving. If you want to use all the tools, you need to be all in.”