By KARIN WANG and CONNIE LO
This month marks the 15th anniversary of an executive order that limited English proficient (LEP) communities rely on to have meaningful access to government services, including health care. Issued by President Clinton in August 2000, Executive Order (EO) 13166 not only reiterated existing obligations of federally-funded entities under Title VI of the Civil Rights Act of 1964 but also expanded the right to language assistance by requiring federal agencies to provide LEP individuals with meaningful access to their services and resources.
As a language access advocate for nearly 20 years and a former federal civil rights enforcement official in the U.S. Department of Health & Human Services, Karin has seen the impact of EO 13166, particularly under the Obama Administration, where there has been much greater attention paid to serving limited English speakers. For instance, many federal agencies now have policy guidance and protocols governing effective assistance to LEP individuals, facilitating much wider access to a range of government-funded programs than a decade ago.
At the same time, the vast number of LEP Americans and the diversity of languages they speak means that there are many ongoing challenges. For example, the Supreme Court’s recent ruling in favor of the Patient Protection and Affordable Care Act (ACA) validated health care reform and secured affordable health coverage for many Americans. But for the many Americans who are LEP – including more than 60 percent of Asian Americans – language presents a daunting barrier to accessing the promise of health coverage.
In our organization’s work as a partner organization of Action for Health Justice, we witness first-hand the challenges facing LEP health care consumers:
Phala is a Cambodian immigrant and speaks very little English. A Chinatown health clinic referred her to us because of her serious health needs, which include hepatitis C, diabetes, hypertension, and permanent nerve damage. Phala is exactly the kind of individual that government healthcare programs target, but from the start she had many problems accessing services. Even with Connie’s help, it took months to get approval of Phala’s application to California’s expanded Medicaid program, and then Phala was repeatedly terminated without cause. The third time it happened, Phala contacted Connie again. She had been trying to refill her critical hepatitis C medications, but the pharmacy denied her prescriptions, telling Phala that her Medicaid was inactive.
Connie began the all too familiar and cumbersome process of contacting our county social services department to help Phala. Connie called the county’s Cambodian language line, but as in past calls, she got an English-speaking worker and was placed on hold for half an hour while the worker searched unsuccessfully for a Cambodian interpreter. More than an hour later, Phala sat silently while Connie argued in English with a county worker. In the end, no interpreter ever joined the call and nothing was resolved. Eventually, our organization had to appeal directly to one of the county’s six division chiefs to ensure that Phala could fill her critical hepatitis C medications.
There are nearly 40,000 Cambodians in Los Angeles County alone, half of whom are LEP. In 1999, Advancing Justice-LA filed a civil rights complaint against the county social services department, which led to the establishment of the Cambodian language line and hiring of more bilingual staff to serve LEP clients. But despite having a Cambodian line, Connie has been able to reach a Cambodian-speaking county representative in only one out of every 10 attempts.
There are more than six million LEP Asian American, Native Hawaiian and Pacific Islander health consumers alone. Even with federal laws and policies like Title VI and the EO 13166, it’s clear that there is still much to be done. As we look ahead to the Fall and the third round of open enrollment in the new healthcare Marketplace, the federal government must take additional steps to ensure that LEP individuals are not inadvertently excluded from health care coverage due to language barriers. We ask federal agencies like the Department of Health and Human Services and the Department of Justice to strengthen their monitoring and enforcement of both Title VI and EO 13166 so that LEP communities can fully realize the dual promises of “meaningful access” and “affordable health coverage.”
Karin Wang is Vice-President of Programs and Communications at Asian Americans Advancing Justice – Los Angeles, formerly known as the Asian Pacific American Legal Center. She previously served as Deputy Regional Manager in the Office for Civil Rights of the U.S. Department of Health & Human Services.
Connie Lo is the Health Programs Coordinator at Asian Americans Advancing Justice – Los Angeles and a Certified Enrollment Counselor for California’s Health Benefit Exchange.