In Most Languages, ACA Does Not Translate

Opinion: When it comes to signing up for health care for 25 million Americans whose native language is not English, the application “tool” in 24 languages is falling short.

Kathy Ko Chin, CEO and president of the Asian & Pacific Islander American Health Forum, is a graduate of the Harvard School of Public Health and Stanford University. 
National Journal
Kathy Ko Chin
Add to Briefcase
See more stories about...
Kathy Ko Chin
March 14, 2014, 1:05 a.m.

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.

AN OPIN­ION ON POLICY AND CHAN­GING DEMO­GRAPH­ICS?

AN OPINION ON POLICY AND CHANGING DEMOGRAPHICS?

The Next Amer­ica wel­comes op-ed pieces that ex­plore the polit­ic­al, eco­nom­ic and so­cial im­pacts of the pro­found ra­cial and cul­tur­al changes fa­cing our na­tion, par­tic­u­larly rel­ev­ant to edu­ca­tion, eco­nomy, the work­force and health. Email us. Please fol­low us on Twit­ter and Face­book.

What We're Following See More »
NOT WORRIED ABOUT BUDGET NEUTRALITY
Trump Wants to Slash Corporate Rate to 15%
27 minutes ago
THE LATEST
PROMISES “MASSIVE” CUTS
Trump Tax Reform Package Coming Next Week
28 minutes ago
THE LATEST

President Trump today said he'll be releasing his tax reformpacakge next week around the 100-day mark of his presidency. He promised that "businesses and individuals will receive a 'massive tax cut ... bigger I believe than any tax cut ever."

Source:
ONLY BROAD PRINCIPLES
Mulvaney: Tax Reform Details Won’t Be Released This Week
29 minutes ago
THE LATEST

Despite President Trump's announcement that his tax reform proposal would be released this week, Office of Management and Budget Director Mick Mulvaney now says it will be ready in June. This week's announcement will be limited to "specific governing principles."

Source:
OFFSHORE OIL AND GAS
Trump To Sign Order Calling For Expanded Drilling
5 hours ago
THE DETAILS

Donald Trump is expected Monday to sign an executive order which will mark his administration's first action on offshore oil and gas drilling. The order is expected to call for a "review of the locations available for offshore oil and gas exploration and of certain regulations governing offshore oil and gas exploration."

Source:
DOMESTIC PRIORITIES
Pence Cuts Asia Trip Short For Big Week
5 hours ago
THE DETAILS

Vice President Mike Pence has cut his Asia trip short "to race back to Washington, where the Trump administration faces a critical week on tax reform and a funding plan to keep the government running, an aide said on Sunday." Pence will return to Washington on Tuesday morning instead of Wednesday. Trump has a busy week ahead, as he plans to roll out a tax reform on framework, sign a number of executive orders, and works to keep the government open past Friday.

Source:
×
×

Welcome to National Journal!

You are currently accessing National Journal from IP access. Please login to access this feature. If you have any questions, please contact your Dedicated Advisor.

Login