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It’s a Matter of Life and Death: Insurers Must Cover Language Services

A 14-year-old girl accompanies her Somali-speaking father to his medical appointment. Because the clinic doesn’t provide an interpreter, the girl has to inform her own father than he has been diagnosed with cancer. She remains his interpreter through eight years of treatment, sometimes hiding information to protect him from the bad news.

A group of Spanish-speaking farmworkers enters a pesticide-laden field and soon, sickened and vomiting, must rush to the hospital. No medical interpreters are provided, and one of the farmworkers must handle communications between her coworkers and health care providers – while she is suffering from her own symptoms.

A Vietnamese-speaking woman is admitted to the hospital. When doctors or nurses need to talk with her, they call in an orderly with no training as an interpreter and no familiarity with medical terminology.

Cases like these are far from isolated. Every day, children, other relatives, friends, and even untrained hospital staff are asked to step in to do a job only competent, professional medical interpreters should be performing.

These dangerous practices persist despite federal law requiring hospitals and other health care providers to offer language services.

These institutions should be meeting their obligations. But it’s also long past time to require insurance companies to make medical interpretation available just as they cover exams, prescription drugs, and other health care essentials.

So far, we’re not holding insurers to that kind of requirement.

As we continue transforming our health care system through the Affordable Care Act (ACA), we need to incorporate professional medical interpretation into those efforts. The federal government should require insurance companies to make medical interpretation available to all patients who need and want it in their course of care.

Letting insurance companies off the hook puts people’s health at risk, allowing insurers to deliver substandard care to people whose health they’re supposed to protect.

Ample research shows that medical interpretation is a necessary component of health care for people with limited English. Without proper interpretation, doctors can misunderstand patient complaints, inaccurately diagnose their conditions, and prescribe inappropriate treatments. Patients receive medications but may not know how to take them.

Often, patients with limited English don’t even make it to the doctor’s office at all. Studies show that patients with limited English are less likely than other patients to have a regular source of health care.

Thanks to the ACA, insurance companies are signing people up in record numbers. They’re marketing health plans to many new enrollees in languages other than English. They’re also enrolling new patients in languages other than English. They should also be able to make health care available in those languages – rather than just pocketing the premiums from those enrollees.

The ACA gives us new tools for holding insurers and providers to their language services responsibilities. We need to do a better job of using all of these tools.

In early September, the federal Department of Health and Human Services (HHS) proposed long-awaited rules to implement the ACA’s ban on discrimination in health care, including discrimination faced by patients with limited English proficiency.

The proposed rules make it clear that oral interpretation is key to combatting that discrimination. They also establish that the new anti-discrimination rules apply to health insurers offering coverage through the ACA. And they require entities covered by the rules to make sure they’re relying on qualified interpreters.

With this language, HHS is building on longstanding civil rights law recognizing people’s right to oral interpretation. But HHS is also building on a history in which that right has been violated, again and again, with violators abetted by inadequate enforcement mechanisms. Patients still are receiving substandard care because of the language they speak.

In a health system increasingly concerned about quality, insurers should make sure all their patients are receiving good health care.

There’s precedent for requiring insurers to step up. Under California’s SB 853, insurers must provide language services at all access points, including the doctor’s office. And, in many states, Medicaid pays for interpretation to help make sure providers are offering it.

If Medicaid programs can cover medical interpretation, so can private insurers. The federal government shouldn’t be letting insurers off the hook while also letting them collect premiums. Patients with limited English have a right to quality health care – and we need to make sure they’re getting it.

(This article was originally published in Huffington Post.)

Let’s Block Too-Big-To-Fail Insurance Mergers

By LeeAnn Hall and Wendell Potter

This article was originally published in Roll Call.

If you thought too-big-to-fail banks were dangerous, watch out for too-big-to-fail health insurance companies.

This summer, the country’s top insurers announced a spate of merger plans, lighting up the business pages nationwide. Health insurance giant Anthem unveiled its intention to absorb competitor Cigna, while Aetna put in a bid for Humana — mergers that, if approved, will cut the country’s big insurers down from five to just three. Add to these proposals Centene’s plan to scoop up Health Net, and it looks like a feeding frenzy.

The bad news is that we’re the bait.

On Sept. 29, the House Judiciary Committee brought company CEOs into a hearing on the deals. There, committee members raised questions not only about competition, but also about the impact of such mergers on both affordability and quality of care.

Meanwhile, the health insurance companies have put their PR in high gear.

In prepared testimony, Anthem CEO Joseph Swedish claimed the merger is about “complementary platforms” and “better value.” But this kind of lingo can’t hide what the proposals are really about: They are not about making quality care more affordable, but about amassing profits in an industry where companies such as Anthem boast profits of $2.5 billion or more a year.

We certainly shouldn’t buy the argument that bigger-than-ever health insurance companies will make our health insurance better or more affordable. If insurance giants grow even larger, we can expect premiums to rise — not go down. Take the example of UnitedHealth’s purchase of Nevada’s Sierra Health Group, triggering premium increases 13.7 percent greater than they would have been without the merger.

There’s also the risk that insurers will squeeze more doctors, hospitals and other providers out of their networks, adding extra hassles and costs for patients. This danger is even higher for those living in low-income communities or rural areas where it’s already hard to find doctors.

As the Sierra example shows, there’s nothing new about insurance company mergers. Anthem attained “megaplan” status 11 years ago when it snapped up WellPoint.

As a result, in many of our cities and towns, a small group of insurers — or even just one — has a real grip on the market. A recent American Medical Association report found a high concentration of insurance markets in 72 percent of metropolitan areas studied, with a single insurer claiming 30 percent of more of market share in 90 of these areas.

Yet, neither the House nor the Senate has a say in these deals. That’s why we need the Department of Justice and our state watchdogs — whether attorneys general or insurance regulators — to take action against these proposals.

Halting the mergers would be consistent with the Affordable Care Act, which gives us the tools to change the terms of competition among health insurance companies. Before the ACA, insurers competed for “good risk” — meaning covering people who were young and healthy and dumping anyone with higher health care needs. Now they can’t turn you down or charge you more for a pre-existing condition. But that doesn’t mean that they’re not still driven by the quest for profits and will try to bend or mold the rules to bolster those profits.

Health Insurance Is Great – Navigators Needed to Help People Use It

This spring, Adriann Barboa and her colleagues at Strong Families New Mexico went on a five-county tour, fanning out across the state to share findings from the Breaking Barriers study they’d conducted on progress under the Affordable Care Act (ACA).

The report is part of a ten-state series by the Alliance for a Just Society.

“In all the towns we went to, many people said it was great to finally have insurance, but they didn’t know how to use it,” Barboa said.

“The Breaking Barriers report recommends using navigators to help people understand what a primary care provider is, what preventive care is, and how to get those services using their insurance,” Barboa said. “Across the five counties people pointed to that recommendation and said ‘That’s what we need.'”

Since passage of the ACA, the United States has seen a record decline in the uninsured rate. In 2013, more than 13 percent of people in the country were uninsured. By 2014, that figure had dropped to 10.4 percent.

These gains were achieved thanks to the ACA’s Medicaid expansion and subsidies for coverage through state and federal marketplaces. The new law made millions of people eligible for health coverage when they’d been shut out in the past.

But, even with these changes, it took real people to get so many new enrollees through the door – these are the navigators mentioned by Barboa.

In the first open enrollment period alone, navigators and other enrollment assisters helped more than 10 million people apply for coverage. These navigators provided information about plans, assisted people with forms, helped them submit documents, and showed them how to make their payments.

This help was – and continues to be – key to the ACA’s success, which is why the federal Department of Health and Human Services is increasing its investment in navigator programs.

We all know how apt the term “navigator” is, since the process of enrolling in health insurance is so complicated. But those complications don’t end once you’re signed up for insurance and have sent off your first premium payment. Using health insurance can be very confusing, too.

Many of us have had questions about our coverage. How do I select a doctor or other practitioner from my health plan’s list of providers? What kind of care comes free of additional costs, and when may I be charged out-of-pocket payments – and how much will those payments be? How do I find out what services or prescriptions are covered? If I’m denied a service, what are my rights to challenge that denial?

These questions are hard enough when you’ve had health insurance your whole life. It’s that much harder if you’re getting coverage for the first time. In that case, you’re entering a new world of formal terminology, provider lists, and paperwork.

That’s why navigator-type programs should be there for us after we enroll, too.

Without an effort to make sure coverage translates into care, we run the risk of missing out on the promise of health reform – which, we should remember, is about transforming our health sector so people can get the care they need. Enrolling all those millions of formerly uninsured people is just the first step.

As the Alliance for a Just Society’s recent Breaking Barriers reports show, many people – especially people of color and low-income people – still aren’t getting into the doctor’s office even after they have coverage.

Some community-based organizations provide good models for how an integrated assistance program can help people move into coverage and then turn that coverage into care.

The Community Service Society of New York (CSSNY) provides one such model. Drawing on funding from New York State, CSSNY has established an innovative coverage-to-care approach – using both a navigator network and a community health advocates program – that helps people obtain coverage and put their coverage to use.

A New Yorker needing help can call CSSNY’s toll-free helpline, where advocates connect people to enrollment assistance, answer questions about coverage, or help troubleshoot insurance issues (such as coverage denials or billing problems). Using a hub-and-spoke structure, CSSNY also works with a broad, statewide network of community group and small business groups, offering help in almost 200 languages.

We need more programs like this one if we hope to truly transform our health care system and make it work for everyone. We need to make sure a person’s insurance card is worth much more than the plastic it’s printed on. Good coverage-to-care navigator programs are key to achieving that goal.

Who’s Really Behind the “Voice of Small Business?”

small biz calculator*This article was originally published in The Hill *

How much does it cost to rebrand a fee levied on health insurers as a “HIT on small business”?

Well, $1.593 million, according to this exposé in the New York Times a few days ago.

A little background: a provision of the Affordable Care Act levies a fee on health insurance companies.  This fee helps to fund the law’s sliding scale premium assistance for individuals, as well as tax credits for small businesses to make health insurance more affordable. It’s expected to cost the insurance industry $100 billion over the first decade.

The New York Times investigation reveals that in 2012, the insurance industry trade group America’s Health Insurance Plans (AHIP) funneled $1.593 million to the National Federation of Independent Business (NFIB) – the self-proclaimed “Voice of Small Business” – doubling down on an $850,000 dark money contribution the year before. Read more

Dumbing Down Health Benefits: More Bad Ideas From Insurance Hustlers

Screen Shot 2014-05-26 at 12.12.19 PMThe U.S. House has passed an interesting little bill titled “Expatriate Health Coverage Clarification Act of 2014.”

This innocuous little title hides behind it a serious threat to both the Affordable Care Act and to some of the 13 million immigrants living and working in the U.S.

The supposed idea behind this bill is to make legal an insurance product for sale to people who spend considerable portions of their time living outside of their countries.

In order to free insurance companies to sell these products the bill exempts this type of insurance from significant portions of the ACA, including minimum benefit coverage. Dumbing down the benefits under the ACA is exactly the wrong direction to take, but there is an even bigger problem with this bill. Read more

ACA Off to Good Start, But Will Coverage Translate to Care?

waiting room photo copyIt was nice to be out in the Pacific Northwest for a few days enjoying the rain, seeing my kids, and spending time over at the Alliance office. It was also good to see the beginnings of the effect that the Affordable Care Act is having. The guy in the bar who tells me his brother was alive because he had qualified for Medicaid. The waiter who tells me he signed up for insurance, even though he is young and healthy.

It was fascinating to sit through an Alliance staff meeting where we were shown the options they have under proposed new health insurance plans. They were being offered pretty comprehensive benefits and a couple of economic choices. The economics had to do with the size of deductions and co-payments the staff thought they could bear.

What is really different are the new limits on how much co-payment and deductability a person has to sustain in a year. Well, it is still pretty steep, between $3,000 and $5,000, depending on your plan, but that’s it. No more $80,000 medical tabs. No more need to sell the heirlooms, the car, and the family home just to survive. Maybe just the car.

This ACA is working, in spite of all the yelling about it on the part of the President’s enemies. Read more

Public Campaign

This is the sixth part in a series of posts that will explore some of the leading organizations from around the country that are engaged in unearthing and combating the influence of money in the political process.

Role in the Landscape

Public Campaign conducts campaigns to improve campaign finance laws and to promote public financing of elections. They offer research and messaging support to community organizations, focusing on connecting the dots between how elected officials raise money and the actions they take that hurt regular people. Read more

A Victory for Health Care Implementation

Last week, the National Association of Insurance Commissioners (NAIC) finalized their recommendations to President Obama on how to implement a critical piece of health care reform: medical loss rations. Their recommendation is a significant victory because,  according to the Washington Post, it largely favors “the views of consumer advocates over those advanced by the insurance industry.” Read more

NWFCO Celebrates New Health Care Law!

I’m signing [this health reform bill] for 11-year-old Marcelas Owens, who’s also here. Marcelas lost his mom to an illness. And she didn’t have insurance and couldn’t afford the care that she needed. So in her memory he has told her story across America so that no other children have to go through what his family has experienced. — President Barack Obama, March 23, 2010 Read more