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
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.

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