Health Care and Language Access

Health Care and Language Access November 16, 2014

That yesterday, November 15, marked the start of the open enrollment period for the health insurance marketplace is a well-known fact at my current place of work, which may be about the only place in America where terms like “health insurance marketplace” or even “Obamacare” have little or no political connotations.  They may elicit groans, but not for the reasons you might expect: for me and my coworkers as telephonic interpreters, what these terms primarily bring to mind is long and often tedious phone calls.  Yet if I am to approach my work in any way as a ministry, I would  do well to remember the larger principle at stake in the provision of language services, namely that of access to essential services for minority-language populations.

Health insurance is of course only one part of this picture, and I’ve written about the same general principle from another angle once before.  Now as then, a couple of news items via the American Translators Association caught my attention for their intersection of linguistic and social concerns.

The first of these indirectly demonstrates how the question of access is particularly prone to get lost in the politically charged and often knee-jerk debates between Obamacare supporters who are so preoccupied with defending it at all costs that they are frequently tempted to gloss over its flaws, and its detractors who have made the impassioned and unequivocal fight against it a cause célèbre for its own sake.  The debate often rages over the heads of people who fall through the cracks in the system – and from what I’ve observed, the system is indeed pretty cracked.

Here is the language access problem in health insurance described in a recent Washington Post article, as summarized by ATA Newsbriefs:

Approximately 115,000 people will lose the coverage they recently purchased through the federal health insurance marketplace because they failed to provide documentation proving they are American citizens or are in the U.S. legally. The Department of Health and Human Services (HHS) has sent multiple notices warning of the deadline and consequences. Immigrant advocacy groups say that since the notices were only provided in English and Spanish, individuals speaking other languages would have been unable to read the warnings. The groups have collectively filed formal complaints with the Office of Human Rights, stating that the HHS failed to meet the language needs of those buying coverage and is in violation of the Affordable Care Act’s nondiscrimination requirements. The complaints acknowledge that the alerts included taglines in several other languages notifying recipients of available interpreter services, but those taglines did not warn them they were in danger of losing their coverage. One complaint filed by an organization serving Asian communities reports that the taglines were not translated in many of their clients’ languages, including Burmese, Lao, Nepali, and Indonesian. The advocacy groups say they previously requested HHS officials to provide more substantial translations for critical health insurance-related notices, but to no avail. Karen Tumlin, an attorney at the National Immigrant Law Center, says the goal is simply to have non-English speakers given a fair chance to fix any problems they might have. “What we’re asking for is so minimal in that sense that it doesn’t have to be necessarily a translation of every single word,” she says. “What we need in these other languages is one to two sentences.”

From “HHS Is Kicking Immigrants Off Obamacare Coverage Without Fair Warning, Complaints Allege”
Washington Post (DC) (10/01/14) Millman, Jason

The minimal scale of these immigrant advocates’ goal is notable here.  Asking applicants for documents proving their immigration status is itself a reasonable request.  And it is equally reasonable, in turn, to expect that this request be communicated in a way that allows for adequate understanding of what is required and “a fair chance to fix any problems”.  I can personally attest to the existence of communication gaps here, since the company I work for often ends up filling in those gaps: I can’t count the number of calls I’ve received from both the marketplace and various insurance companies with customers who have received notices they don’t understand, or who need help untangling unduly complicated situations even after providing all the requested information.

Another item in the same news briefing caught my interest for a similar reason, relating more directly to doctor-patient communication, particularly in New York City hospitals, which I communicate with on a pretty much daily basis (often multiple times a day).

With a Chinese patient population of approximately 30 percent, the New York Hospital of Queens has launched a monthly health education series for native Chinese-speakers. The lectures are part of the hospital’s Community Health Initiatives program. While local leaders have praised the hospital for going beyond basic language access rights, the program is also a reminder of how much is not being done in other communities. More than 1.8 million of New York City’s 8 million residents have limited English proficiency (LEP), according to the Mayor’s Office of Immigrant Affairs. The Joint Center for Economic and Political Studies reports that the LEP population is underserved in healthcare and that the resulting inequalities come at great expense to the economy. Gayle Tang, Senior Director of National Diversity and Inclusion at Kaiser Permanente, agrees and says, “Organizations, leaders, and decision-makers really need to understand that language access is a business imperative, not a minority issue.” Language access advocates also point out that patient education is just a small piece of the bigger picture. Researcher Cindy Brach of the Agency for Healthcare Research and Quality says the problem requires a multi-pronged approach, including availability of healthcare information in a patient’s native language, medical interpreting services, and translation of discharge instructions. Experts cite interpreting services as an example of how difficult it has been to make progress. Although a 2006 law mandated free language services in the city’s top six non-English languages, there is still a significant difference in how the law is being carried out, especially in access to interpreters. New York Immigration Coalition Advocate Claudia Calhoon says even getting healthcare providers to consistently use interpreter services is a challenge. Tang remains hopeful, however. “It’s a matter of people getting together and being able to leverage each others’ resources,” she says.

From “Healthcare in Translation”
NY City Lens (NY) (10/20/14) Lem, Pola Aniela

I chafe somewhat here at the stronger emphasis put on the almighty economy above the need for vulnerable populations to be able to communicate with care providers, as in the quote stating “that language access is a business imperative, not a minority issue.”  Actually, it’s both.  If Tang had said, “not only a minority issue”, I would agree.  To be fair, it’s entirely possible that that’s what she meant, and that she was trying to persuade people from a business angle who may not be as easily persuaded by a moral one: well and good.  For Catholics, however, it is important to remember that from the standpoint of our Church’s social teaching, human needs – especially among the most vulnerable – must come first.  Not that economic concerns are necessarily unrelated, but they are secondary.  As Pope Francis likes to remind us, it’s when the economy becomes detached from consideration of human dignity and is considered rather for its own sake that it becomes an idol.

One more point should be addressed on the subject of language access for America’s many minority-language residents.  Some will surely mention the duty of expatriates to learn the language of their adopted home, and indeed rightly so: these concerns are not contradictory but complementary, not least because of the strong desire among these same foreign-language populations themselves for the empowerment that comes with learning English.  I would not want to be such a blindly biased advocate of language services as to dismiss the education that is surely the most empowering thing in the long run.  Nor, by the same token, should these services be feared as a disincentive to that education: having to rely on an interpreter is still a vulnerable position to be in.  No language service can eliminate the vulnerability of living with a language barrier; they can only mitigate it.  And it must be mitigated in the meantime, because nobody can learn a language overnight, and there are plenty of people who can’t afford the time it takes to do so before learning how to keep from losing their insurance or what medical treatment to follow.

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