By Kathy Ko Chin
Asian & Pacific Islander American Health Forum
Oakland, Calif. (Nov. 30, 2015) — It’s difficult to ask a doctor for help when you both speak different languages. How do you tell your doctor what hurts? What about your medical history? How do you ask the pharmacist for your medication? How do you apply for health insurance? Where do you start?
This is a challenge facing millions of people in the United States when it comes to health care and insurance. These people who have a limited ability to understand or speak English, known as limited-English proficient (LEP), are some of the most uninsured and possibly some who receive the least amount of care in our communities. Census data reports there are about 25 million people in the United States who do not speak English well, including one-third of the Asian American, Native Hawaiian, or Pacific Islander (AA and NHPI) population. As 71 percent of AAs and 29 percent of NHPIs speak a language other than English at home, this decreases their likelihood to seek out information on health insurance, or being able to use their coverage once insured, as most resources are not available in Asian or Pacific Islander languages. As we begin the third Open Enrollment Period for the Health Insurance Marketplaces, it is essential that we focus our efforts on those who are hardest to reach, especially those who are left out due to language barriers.
With Action for Health Justice (AHJ), a national coalition of more than 70 groups including community-based organizations and health centers, we have seen first-hand the challenges facing these individuals and their families. During the first two Open Enrollment Periods, we reached and enrolled nearly 850,000 AAs and NHPIs. Our partners worked in 22 states to provide one-on-one assistance in 56 Asian and Pacific Islander languages. They found in-language outreach to be difficult as most reference tools and materials were only in English or Spanish. Furthermore, they found it challenging to clearly explain insurance terms and concepts in Asian and Pacific Islander languages and for communities who may never have had private coverage before.
In order to provide AHJ partners with easy-to-understand definitions for common health and insurance terms, we published a free glossary available in English and 12 Asian and Pacific Islander languages that provides definitions for 100 of these common terms. Understanding the meaning of “deductible” and “premium” can be hard enough, but navigating those terms in a different language is even more challenging. In communities where one in three have difficulty speaking, writing, reading or understanding English, this work is crucial to reaching AAs and NHPIs who would otherwise be unable to access information and enroll in health insurance.
For Hoang, a Vietnamese fisherman in Louisiana, the journey to health insurance could have ended early if it weren’t for in-language assistance. With a Vietnamese interpreter from MQVN, a community health center, he was able to complete his enrollment paperwork and gain coverage during the previous enrollment period. Hoang was able to visit a doctor and learned that he has hepatitis B, a viral infection that can be fatal if not treated early. Thanks to in-language assistance and resources, Hoang is now receiving treatment and is fully insured.
There are thousands of people just like Hoang in our communities whose greatest barrier to health care and health insurance is the language they speak. As we move further into this Open Enrollment Period, the availability of assisters, interpreters, and in-language resources becomes all the more valuable to our efforts. Language barriers pose such a challenge in every aspect of health care and health insurance that part of the Affordable Care Act (ACA) prohibits discrimination based on language along with discrimination on the basis of race, color, national origin, sex, age or disability.
In September, the federal government released draft regulations implementing the ACA’s nondiscrimination provision protecting civil rights in health care, Section 1557 Nondiscrimination in Health Programs and Activities. Section 1557 protects all Americans from discrimination in health care based on their English proficiency when they are relying on federal health care programs, the Health Insurance Marketplaces, and many other providers. It is good policy that brings us closer to health equity for all communities.
Although we are making progress, we have a long way to go to fully ensure that everyone has access to the health programs and services for which they are eligible and need. Section 1557 must be fully implemented and give needed guidance to state agencies and assisters across the country. Our partners will continue working alongside other community-based organizations and clinics to ensure all people have access to health care information and resources. To achieve full health equity, we must ensure that all people and all communities can access our health care system – no matter what language they speak.
Kathy Ko Chin is the president and CEO of the Asian & Pacific Islander American Health Forum, a member of Action for Health Justice (AHJ). AHJ is the only national coalition dedicated to ensuring that Asian Americans, Native Hawaiians and Pacific Islanders realize the benefits of the Affordable Care Act.