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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.)

Report: Racial Health Disparities Magnified in California Under ACA

FOR IMMEDIATE RELEASE
Tuesday, May 5, 2015
Contact:
Kathy Mulady, communications director
kathy@allianceforajustsociety.org
(206) 992-8787

Breaking Barriers to Health Care Access in California

“Obamacare didn’t cause the widespread racial disparities we found,
but neither did it solve them.”

More Californians than ever before have health insurance, but coverage isn’t care, and the Affordable Care Act has magnified the deep racial, ethnic and cultural disparities in accessing quality health care in California.

Latino and African Americans especially remain heavily uninsured and struggle to receive health care.

Language and cultural barriers, lack of Internet or an email address, a lack of experience in using health insurance, a shortage of doctors and clinics in poor and rural communities, and high costs are preventing many from receiving health care and medications.

A new report “Breaking Barriers: Improving health insurance enrollment and access to health care in California,” reveals a deep divide between social class, income, culture and ethnicity emerging under the state’s Covered Care.

“It’s unconscionable that so many have been left out of something as basic as the chance to enjoy good health,” said Gary Delgado, author of Breaking Barriers. “Lack of Internet access or speaking another language is not a reason to be locked out of a health system that purports to be open to all.

“Obamacare did not cause the widespread racial disparities we found, but neither did it solve them. Now we have to take them on directly,” said Delgado.

“Breaking Barriers” s a year long study that includes a survey of nearly 1,200 low-income people in 10 states in Spanish, Cantonese, and English. They were contacted at food banks, health clinics, and homeless centers.

Alfredo DeAvila did surveys and interviews for the Breaking Barriers California report.

“If the ACA is going to be successful, we need to help people transition not only into the health insurance system, but also into the health care system,” he said. “We must invest in public education about how to get ongoing preventive care.”

The Korean America community, especially seniors are struggling because of costs, said DJ Yoon, executive director of NAKASEC (National Korean American Service and Education Consortium.)

“California can be a leader in assuring quality health care for all people. We have let people of color again slip through the cracks in our system, we can do better – and here is a roadmap for how we get there,” said Delgado.

Key recommendations in the report include:

  • Improve language access. Make provider directories available in multiple languages and list addresses, phone numbers, languages spoken, hospital affiliations, and specialties.
  • Simplify the insurance-shopping experience. Make cost information transparent and communicate clearly about deductibles, co-pays, and preventive services that are included.
  • Covered California should enforce and impose penalties on insurers who do not reduce racial health care disparities within required timeframes.
  • Assure that primary care providers are within 30 minutes driving or public transit time. Enrollees who must travel further should be offered free transportation.
  • Expand school-based health centers, especially in medically underserved communities.
  • Address underlying causes of poor health, especially in poor communities, (mold, infestations, domestic violence) Expand medical-legal partnerships as an avenue toward addressing poor health in low-income communities.
  • Reinforce the ACA-mandated “well-woman preventive” care and provide education about the value of preventive care for all. Ensure that all plans include reproductive health care services.
  • Require that new enrollees are offered a free physical exam, appropriate screening tests and other preventive care within 60 days of enrollment.

Here is the link to the full Breaking Barriers in California report: http://allianceforajustsociety.org/wp-content/uploads/2015/04/BBReport_CALIF.pdf

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The National Korean American Service & Education Consortium (NAKASEC) brings a progressive voice to civil rights and immigrant rights issues and promotes full participation of Korean Americans in building a movement for social change.

The Alliance for a Just Society is a national policy, research and organizing network focused on racial and economic justice. The Alliance has produced pivotal reports for 20 years on state and national health issues including Medicaid, prescription drugs, and insurance industry practices.

 

Washington CAN!: Medical Interpretation Victory Empowers Patients and Workers

For eight years, I was the interpreter for my father while he was sick. At the age of 14, I was more his interpreter than his daughter. I worried about how I would tell my father that another part of his leg would be amputated or whether he was going to survive another surgery. Sometimes I would spare my father bad news despite the doctor’s orders. I would decide whether or not to tell the nurse if my father had eaten that day based on the pain the IV would cause him. Read more