Health reform is supposed to bridge the gap between the haves and have-nots when it comes to insurance, but language barriers are standing in the way.
This is the situation many of the more than 25 million Americans who have difficulty communicating in English face as they struggle to navigate the Affordable Care Act. For these Americans—known as "limited-English proficient"—the health insurance marketplace is just another closed door.
Despite the fact that 79 percent of this population speaks Spanish, Chinese, Vietnamese, Korean or Tagalog, federal education efforts about the health law have largely been in English. Even with the Spanish language site CuidadoDeSalud.gov—four out of five of the most commonly spoken languages are out.
The dearth of resources is so large that nonprofit coalitions headed up by national, state, and local partners are relying on private foundation dollars to reach Asian, Pacific Islander, and other minority in-language speakers. Where one would expect federal resources to be doing the job, these organizations are developing educational brochures and hosting community town halls to get out the message about enrollment.
Even when well-intentioned federal efforts have targeted non-English speakers, the results have been disappointing, ranging from problematic to wholly inaccurate.
Translation requires more than just word-for-word substitution. In order to be accurate and useful, translators must take into account the literal content along with cultural and phonetic nuances. Yet, some of the materials on HealthCare.gov fall woefully short of this standard.
Take for example, translations of basic Marketplace documents.
The Tagalog version of The Value of Health Insurance, simply swapped the word "deductible" with "bawas gastos." The problem is the latter means a "reduction in cost" or "less expensive"—far from the real meaning of the term deductible, which is the amount you pay rather than less spent.
Apart from translation issues, non-English speakers face an application that simply does not meet their needs. For these groups, the difference between what is supposed to be and what really is have become glaringly apparent.
Health care navigators and community members are spending hours walking people through the process. The new application—confusing enough in its own right—can be insurmountable for people with language barriers. Even though there is an application "tool" in 24 languages, non-English speakers can only apply in person or through the federal call center.
Since there are no translated materials in Lao, one Illinois organization has had to rely on bilingual counselors as a work-around. But with no standard glossary of terms available, counselors have struggled to accurately convey complicated insurance language in Lao.
At the same time, while visitors to HealthCare.gov are told that help is available via telephone in 150 languages, hold times can discourage even the most determined caller. Callers are supposed to be connected with an interpreter, who, along with a trained operator, can answer their questions about eligibility and enrollment. The reality, however, can be quite different.
Despite considerable improvements since the Oct. 1 launch, wait times for languages other than Spanish are still unacceptably long. One caller needing help in Bosnian had to wait 30 minutes for an interpreter—a far cry from HHS' goal of a 60-second connection. Another caller was told, incorrectly, that help was only available in English and Spanish. While anecdotal, these experiences are concerning since there is no way to know how many people hang up and stop trying.
Meaningful access to federal programs is a right and one which federal officials and health advocates have worked tirelessly for years to make a reality. Title VI of the Civil Rights Act of 1964, Executive Order 13166, and the landmark Supreme Court case Lau v. Nichols clearly establish that federally funded programs and activities cannot discriminate on the basis of language.
The ACA—historic and aspirational as it may be—is falling short of this right.
Better accountability, targeted action, and funding are needed. Federal officials have the obligation to ensure that translated documents are accurate and accessible. Outreach campaigns must include languages other than English and Spanish. And, the common application should be available for consumers to complete in 15 of the most commonly spoken languages.
The challenges and frustrations of limited-English-speaking Americans provide an impetus to do better come the second open enrollment and beyond. After all, making sure that all eligible Americans know their coverage options and are able to enroll is the law.
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