Q&A: ACA Basics Beyond Language Barriers

Translating the particular into 15 languages is only one of the hardy challenges that Obamacare faces during the rollout to America’s communities of color.

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
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Kathy Ko Chin
Oct. 24, 2013, 2 a.m.

Kathy Ko Chin  poses ques­tions she thinks need to be asked, from her po­s­i­tion as pres­id­ent and CEO of the Asi­an & Pa­cific Is­lander Amer­ic­an Health For­um.

Com­plaints about Health­Care.gov have been pil­ing up. Are people ac­tu­ally able to en­roll and what ef­fects will this have on the en­roll­ment goals and suc­cess of the law?

As Pres­id­ent Obama has ac­know­ledged, there have been some early tech­nic­al set­backs, res­ult­ing in long wait times and is­sues pro­cessing ap­plic­a­tions. The good news is that wait times are im­prov­ing and ad­dress­ing these is­sues is a top pri­or­ity. Re­mem­ber, health re­form is dif­fer­ent in every state, and for the states op­er­at­ing their own mar­ket­place, the news has been prom­ising. New York, for ex­ample, has had skyrock­et­ing de­mand for cov­er­age, and Wash­ing­ton state has pos­ted some great num­bers in the past three weeks. One thing is cer­tain, des­pite the back and forth polling on the law, the 20 mil­lion vis­its to Health­Care.gov tell us that Amer­ic­ans are ex­cited about their new cov­er­age op­tions and hungry to get en­rolled.

The in­di­vidu­al man­date is linked to two ma­jor changes the Af­ford­able Care Act made to how in­sur­ance com­pan­ies op­er­ate in the in­di­vidu­al mar­ket. Un­der the ACA, in­sur­ance com­pan­ies can no longer deny cov­er­age on the basis of a preex­ist­ing con­di­tion and they can­not charge sick people more. The man­date is de­signed to cre­ate a broad in­sur­ance pool by re­quir­ing every­one, both sick and healthy, to have cov­er­age. Without a man­date, healthy people could wait un­til they ac­tu­ally need in­sur­ance, cre­at­ing an un­bal­anced in­sur­ance pool dom­in­ated by those with ex­pens­ive med­ic­al needs. This would drive up premi­ums for every­one and is known as “ad­verse se­lec­tion.” The non­par­tis­an Con­gres­sion­al Budget Of­fice found that get­ting rid of the man­date would raise premi­ums by 15 per­cent to 20 per­cent.

Kathy Ko Chin is president and CEO of the Asian & Pacific Islander American Health Forum, a nonprofit that focuses on policy, programs, and research to improve the lives of Asian-American and Pacific islanders. (Courtesy photo) Courtesy photo

Kathy Ko Chin is pres­id­ent and CEO of the Asi­an & Pa­cific Is­lander Amer­ic­an Health For­um, a non­profit that fo­cuses on policy, pro­grams, and re­search to im­prove the lives of Asi­an-Amer­ic­an and Pa­cific is­landers. (Cour­tesy photo)More than 24 mil­lion people in the United States are con­sidered lim­ited-Eng­lish pro­fi­cient, and sev­er­al LEP stud­ies have doc­u­mented the con­sequences of com­mu­nic­a­tion bar­ri­ers in health care. However, the fed­er­al gov­ern­ment only plans to have in­sur­ance ap­plic­a­tions in Eng­lish and Span­ish. Will this be det­ri­ment­al to the ACA achiev­ing its chief goal?

Due to budget con­straints, there is not enough money to trans­late the health-ex­change ap­plic­a­tion in­to the min­im­um 15 lan­guages needed. The Health and Hu­man Ser­vices De­part­ment has set up an in-lan­guage hot­line that is sup­posed to of­fer as­sist­ance in 150 lan­guages. However, test­ing on the ground has re­vealed some prob­lems with the hot­line, with wait times of up to eight minutes for lan­guages oth­er than Span­ish and par­tic­u­larly for Asi­an and Pa­cific Is­lander lan­guages. This will be a ma­jor prob­lem as open en­roll­ment moves for­ward. States like Cali­for­nia and dozens of health ad­voc­ates across the coun­try are work­ing to provide in-lan­guage ma­ter­i­als to en­sure that those who do not speak Eng­lish at all or not very well are not left out of the open-en­roll­ment pro­cess.

Ana­lysts have said the mar­ket­place will only be suc­cess­ful if it can get enough young, healthy people in the in­sur­ance pools. Will young people ac­tu­ally sign up or just pay the pen­alty for not hav­ing cov­er­age?

That’s cor­rect; to keep premi­ums af­ford­able for every­one, healthy young people must sign up for cov­er­age in the mar­ket­place, and ana­lysts be­lieve that will hap­pen.

With 19 mil­lion un­in­sured young adults, the “young in­vin­cible” idea is really a myth. Re­search shows that when young adults are offered cov­er­age they can af­ford, they take it. Already, 2.5 mil­lion young adults have chosen to stay on their par­ents’ plan.

This tells us that young adults want and need cov­er­age. Un­der the law, those mak­ing less than $45,960 will get fin­an­cial as­sist­ance that, de­pend­ing on their state and in­come, could bring cov­er­age to un­der $100 a month. The ques­tion dur­ing open en­roll­ment isn’t as much as do young adults want cov­er­age; it’s how to make sure they know what their op­tions are and can af­ford cov­er­age.

Most busi­nesses in the U.S. are small busi­nesses, and the most re­cent census data, re­leased in 2010, in­dic­ated about 21 per­cent of U.S. busi­nesses are owned by minor­it­ies. There have been re­ports of busi­nesses lay­ing off em­ploy­ees or cut­ting their hours be­cause of the ACA. We’ve also heard that the ACA will help small busi­nesses af­ford health in­sur­ance for their em­ploy­ees. So how will the ACA really af­fect small busi­nesses?

There is a lot of con­fu­sion about the ACA among busi­ness own­ers, and some are tak­ing ac­tion, such as cut­ting em­ploy­ee hours, be­cause they simply do not know how the law will really af­fect them. Oth­er em­ploy­ers, namely lar­ger ones, are mak­ing changes that are in­flu­enced by factors oth­er than the ACA.

The ACA helps to level the play­ing field for small busi­nesses (defined as hav­ing few­er than 50 em­ploy­ees) by of­fer­ing them ac­cess to a mar­ket­place where they can shop for and buy the same kinds of in­sur­ance plans that were pre­vi­ously only af­ford­able for large com­pan­ies. Small em­ploy­ers can also get tax cred­its to help them cov­er the cost of monthly premi­ums. By of­fer­ing health in­sur­ance cov­er­age, small busi­nesses will now be able to at­tract and re­tain more em­ploy­ees. Even if small em­ploy­ers choose not to provide in­sur­ance, their em­ploy­ees will now have new, af­ford­able health in­sur­ance op­tions in the in­di­vidu­al Mar­ket­place.

The U.S. spends more on health care than most in­dus­tri­al­ized na­tions. In 2011, we spent more than 17 per­cent of our GDP on health. Will the ACA do any­thing to bring down costs?

We need to real­ize that the United States’ in­flated health-care spend­ing is the res­ult of a num­ber of com­plex factors. The ACA helps to ad­dress some, but not all. We spend more of our GDP on health care than most oth­er na­tions, and we spend al­most twice as much per per­son than those same na­tions. The reas­ons are mul­ti­fold, in­clud­ing the high cost of health in­sur­ance and cor­res­pond­ingly high num­bers of un­in­sured Amer­ic­ans, ad­min­is­trat­ive and billing costs, pri­cing for health ser­vices and use of ex­pens­ive test­ing, among many oth­er factors.

The ACA is a huge start, but it will not fix everything. The law will drastic­ally re­duce the num­ber of un­in­sured, im­prove ac­cess to af­ford­able pre­vent­ive health care, elim­in­ate in­sur­ance com­pany prac­tices that have kept Amer­ic­ans un­in­sured or un­der­insured, and im­ple­ments new pay­ment re­forms. These re­forms in­clude changes to how Medi­care pays for pre­vent­able hos­pit­al ad­mis­sions, new health care de­liv­ery mod­els, and oth­er strategies to im­prove health out­comes and lower costs.


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