THE BLOG
11/13/2014 11:09 am ET Updated Jan 13, 2015

Language Access Key to Keeping Health Care Doors Open to All

Imagine losing your health coverage after doing everything you were supposed to do under the new health reform law. You filled out the forms, sent in the paperwork, chose your health plan, and began paying premiums. Now you learn that you're going to lose coverage anyway.

That was the situation for approximately 115,000 people around the country who were recently dropped from the federal health insurance exchange. The reason they lost coverage? They didn't send in immigration documentation that the exchange was requesting. But, in many cases, the enrollees had a good reason not to: the exchange didn't tell them about the requirement in a language they could read.

The federal exchange is not alone in failing to provide adequate interpretation and translation for people of limited English proficiency.

Even states that led the country in establishing health exchanges and had robust enrollment overall are seeing a serious under-representation of enrollees with limited English proficiency. Recently, the Greenlining Institute found that "80 percent of enrollees in private plans spoke English, even though 40 percent of those eligible for coverage were limited-English proficiency individuals."

With health exchange enrollment opening again on Saturday, Nov. 15, it's crucial that both federal and state exchanges get it right when it comes to language access. That means providing the interpretation, translation, outreach and enrollment support in languages potential enrollees can understand.

Without these measures, the results are disastrous - families without access to health care - and undermine health reform's goal of getting coverage to everyone in the United States.

Recently, the National Immigration Law Center (NILC), along with two organizations assisting immigrant communities in other parts of the country, filed administrative complaints with the federal government, claiming that language access failures violate potential enrollees' civil rights.

One of the organizations joining NILC is the Southeast Asian Mutual Assistance Associations Coalition (SEAMAAC), which works with refugees and immigrants in Philadelphia. In its complaint, SEAMAAC describes an enrollment process full of obstacles - the sorts of obstacles that have been resolved for most people seeking coverage, but that remain for many immigrants.

As these immigrants sought coverage, they were pressed for additional information and documents, without the translation and interpretation needed for them to meet this demand.

SEAMAAC's complaint and supporting statement describe barrier after barrier for immigrants. The enrollment websites often didn't accept special identifier numbers that non-citizens were required to submit.

Immigrants who attempted to submit applications online, called the call center (which often had no interpreters available), sent in documents, and often had to repeat the process multiple times. SEAMAAC staff notes that, on average, they submitted clients' immigration documents two or three times.

For many, though, even that wasn't enough, and the federal exchange sent out notices requiring more documentation. However, the full notices were sent only in English and Spanish, without warnings in other languages indicating that recipients' health insurance was at stake. Notices such as these are meaningless for people whose primary language is Chinese, Vietnamese, or any language that isn't English or Spanish.

Groups working with immigrants around the country echo the experiences described by SEAMAAC, whether in states that have established their own exchanges or those using the federal exchange.

Without improvements in language access, the exchanges are sending a troubling message to immigrants: the doors to our new health care system - and to health care itself - are shut to you.

The drafters of the federal health reform bill knew, as the song says that "good intentions just ain't good enough," and that's why they included civil rights protections in their legislation.

These protections were intended to ensure that people get information about the enrollment process in a language they understand--and that, when they go to the doctor's office, they receive professional interpretation so they can communicate with their health care providers.

These language access requirements should be more than just good intentions written on paper. They should be real obligations designed to get health care to everyone who falls under health reform's protections. Health reform won't be a success until language access becomes a reality.