In this brief for the Center for Studying Health System Change (HSC) and sponsored by the Robert Wood Johnson Foundation authors Judith H. Hibbard and Peter J. Cunningham report that consumers who have poorer overall health, less education and a lower income, or who are Medicaid enrollees, are less likely to be engaged in their health care. Findings also indicate that consumers with lower patient activation levels lack basic knowledge, confidence and support on how to manage their health.