A mere four weeks lie ahead of the Affordable Care Act's (ACA) second open enrollment period and all eyes are on Health and Human Services Secretary Burwell to avoid the glitches that plagued efforts last fall. The consensus among health advocates is clear: this year's enrollment will be even more difficult. The second time around, enrollment assisters will have half the time to do double the work of both reaching those who are still uninsured and keeping people enrolled.
Connecting with uninsured immigrants and people who speak limited English will be the hardest part. If history is any indication, in-person assisters will increasingly be tapped to fill in the gaps, stretching themselves thin.
The reasons are multifold. There were very few materials available in languages other than English and Spanish at the federal and state marketplaces, and the few that were available have since been removed from the federal site. As health organizations, including my own, recently noted in a new report by Action for Health Justice (AHJ), the state of play for non-English speakers during last year's enrollment was abysmal. Healthcare.gov, the portal for consumers in 36 states, was available only in English and Spanish -- and the quality of the Spanish-language translation was poor -- leaving limited English-speaking consumers in the dark about their coverage options and obligations under the law.
And enrollment efforts by state marketplaces weren't always better. The materials produced were underwhelming, often containing inaccurate translations rendering them impossible to use. Even efforts by leader states like California and New York fell short. Documents were overly technical and inaccessible or plagued with meaningless literal translations.
This meant people who were not proficient in English or Spanish were left with only two enrollment options: rely on the call center or get in-person help. In-person assisters served as a lifeline, connecting people to coverage who otherwise would have remained uninsured. Jackie LeSage and her colleagues at the Samoan National Nurses Association, for example, made five-hour drives to reach Marshallese communities in Spokane, Washington. They worked with trusted community leaders and educated them about the ACA, their coverage options and helped get them enrolled. These Marshallese community members would never have been able to enroll -- let alone know about available financial assistance -- without this help. And because Jackie has bilingual interpreters on staff, they were able to accurately explain complicated insurance concepts and provide in-language health education.
Jackie's work was part of AHJ's broader strategy to demonstrate how reaching diverse communities is possible. Just a modest investment in a national, coordinated effort can result in big enrollment gains. During the first open enrollment period, AHJ reached over 600,000 Asian Americans, Native Hawaiians and Pacific Islanders through its network of over 70 community based partners in 22 states. They provided the on-the-ground support that made all the difference when it came to getting covered or not.
Meanwhile, language and health literacy barriers were compounded for immigrants who had to jump through multiple hurdles just to get enrolled, and many of these barriers remain. The problems were so pervasive that the National Immigration Law Center and SEAMAAC, a member of AHJ, recently filed a civil rights complaint over the announcement that CMS would terminate coverage for 115,000 people who did not respond to requests for additional citizenship or immigration documents. The complaint details how limited English-speakers were left in the dark because the notices were only translated into English and Spanish. And, while the letters included taglines -- one-sentence statements -- in select Asian languages, the text was so generic it failed to convey the gravity and urgency of the situation that a person's coverage would be cut off without a response.
Despite these serious shortages in consumer access and customer care services for limited English-speakers and immigrants, communities that are disproportionately uninsured and low-income, there is little cause to believe that the second open enrollment will be much different. It's not too late for federal officials to make meaningful language access a reality. Let's hope policymakers at the state and federal levels use the next month to get enrollment right this time.