Myriad languages, cultures challenge health reform
Associated Press
March 4, 2013
By GARANCE BURKE and JUDY LIN
OAKLAND, Calif. – Set on a gritty corner of Oakland’s International
Boulevard, the nonprofit Street Level Health Project offers free
checkups to patients who speak a total of 22 languages, from recent
Mongolian immigrants seeking a doctor to Burmese refugees in need of a
basic dental exam.
It also provides a window into one of the challenges for state
officials who are trying to implement the Affordable Care Act,
President Barack Obama’s sweeping health care overhaul.
Understanding the law is a challenge even for governors, state
lawmakers and agency officials, but delivering its message to
non-English speakers who can benefit from it is shaping up as a
special complication. That is especially true in states with large and
diverse immigrant populations.
For Zaya Jaden, a 35-year-old from Mongolia, getting free care for her
sister’s persistent migraine was a much higher priority than
considering how the expansion of the nation’s social safety net
through the Affordable Care Act might benefit her.
The sisters crammed into the clinic’s waiting room, sandwiched between
families chatting in the indigenous Guatemalan language Mam, and
discussed whether enrolling in Medicaid under the Affordable Care Act
would work for the family’s finances.
“It was a good idea that Obama had, but I don’t know if it will work
for me,” said Jaden, who gets private insurance for her family through
her job as a laundress at an Oakland hotel and currently makes too
much money to qualify for Medicaid. “If I make less than what I make
to try to qualify for the government program, how could I pay my
rent?” Jaden’s ambivalence demonstrates the cultural and language
hurdles that California and several other states are facing as they
build exchanges – or health insurance marketplaces -and try to expand
coverage to ethnic and hard-to-reach populations.
California has the largest minority population of any state, about
22.3 million people. That’s followed by Texas with 13.7 million, New
York with 8.1 million, Florida with 7.9 million and Illinois with 4.7
million.
In Illinois, where nearly 1.2 million residents don’t speak English
well, the task of translating information about the health care
overhaul into other languages has fallen to nonprofit groups and
community organizations.
“So far it’s fallen to us, and we don’t know what (the state’s)
capacity will be to go beyond Spanish,” said Stephanie Altman of
Health and Disability Advocates.
The state intends to submit an outreach plan to the federal government
this spring. Illinois officials expect federal grant money eventually
will be available to help reach non-English speakers, said Mike
Claffey, a spokesman for Democratic Gov. Pat Quinn.
The U.S. Census estimates that more than 55 million people speak a
language other than English at home. Nearly 63 percent of those are
Spanish-speakers, with the highest concentrations in Texas, California
and New Mexico. Chinese was the third most commonly spoken language,
with large populations in California, New York, Hawaii and
Massachusetts.
Five other languages have at least 1 million speakers: Tagalog,
French, Vietnamese, German and Korean.
In California, two-thirds of the estimated 2.6 million adults who will
be eligible for federal subsidies in the health care exchange will be
people of color, while roughly 1 million will speak English less than
very well, according to a joint study by the California Pan-Ethnic
Health Network and the UCLA Center for Health Policy Research and the
University of California, Berkeley Labor Center.
With such diversity in cultures and language, the authors said the
success of health care reform “hinges in large part on how well the
state conducts culturally and linguistically competent outreach and
enrollment efforts.”
“If the exchange did no targeted outreach, there could be 110,000
fewer limited-English proficient individuals enrolled,” said Cary
Sanders, director of policy analysis for CPEHN, an Oakland-based
multicultural health advocacy group.
Even the relatively mundane task of developing a brand for
California’s new health care exchange has prompted some angst.
The exchange’s staff tried to come up with a name that signified
health insurance and would translate well into Spanish, Chinese,
Tagalog, Vietnamese and other languages commonly used in California.
The exchange’s five-member board settled on “Covered California” and
is currently testing tag lines to see which words resonate best in
focus groups. Advocates disappointed by the name are hoping the board
selects a tag line that will be simple to understand and translate.
Jaden, for instance, said she had no idea how “Covered California”
would translate to Mongolian.
More importantly, they want Covered California to launch an inclusive
marketing and outreach campaign in a place where a majority of the
population is not white and nearly 7 million residents speak limited
English.
“‘Covered California’ translates to California Cubierto in Spanish,
but what exactly does it mean?” said Laura Lopez, Street Level Health
Project’s executive director, who immigrated to the United States from
Peru years ago. “It’s not just providing a piece of paper that says
this is what is covered. It’s really having people on the ground
talking with the community.”
California’s exchange isn’t shying away from the challenges.
Its executive director, Peter Lee, recently announced that new federal
funding will be used to support a multi-language campaign, build a
network of community-based assistants who can guide people to the
right health plan and multilingual call centers.
The exchange is making $43 million available for community-based
organizations, faith-based groups, nonprofits and local governments to
compete for outreach and education grants.
“California is unique from every other state not only geographically
because our population is spread out, but you have multiple ethnic
populations that are traditionally hard to reach, and they need their
own custom way to be reached,” said Oscar Hidalgo, the exchange’s
communications director.
The exchange estimates that 5.6 million Californians are without
health insurance, or 16 percent of the population under age 65. Of
that number, 4.6 million are eligible for coverage under the
Affordable Care Act, while the rest are not because of their
immigration status.
Advocates say California should refine its efforts to reach
non-English speakers.
Doreena Wong, who promotes health access for immigrants at the Los
Angeles-based Asian Pacific American Legal Center, is among those
urging the exchange to build a website that is not just in English and
Spanish, but to offer translations in other languages prevalent
throughout the state: Arabic, Armenian, Chinese, Farsi (Persian),
Hmong, Khmer (Cambodian), Korean, Russian, Tagalog and Vietnamese.
According to the U.S. Department of Health and Human Services Office
for Civil Rights, organizations that receive federal funding have to
provide written notices in English, Spanish and other languages spoken
by 10 percent or more of the households in the area they serve.
Wong recently told the board that many people eligible for the
exchange aren’t proficient in English, have limited education or have
never had health care insurance. Other groups have requested the
exchange, at a minimum, add Chinese.
Hidalgo said the state’s health exchange website,
, is being created in such a way more
languages can be added later. He said the exchange first needs to
launch an introductory website where consumers can learn about
impending health care changes, such as federal subsidies for working
families and tax credits for small businesses.
“It’s very challenging to put together a website that’s consumer
friendly in English, and then to do it in 13 languages is a very, very
big task,” he said. “I think what’s important for us is to take a step
in English and Spanish and figure out what the feedback is. … We
don’t have all the answers at this moment, but we’re going to find
them.”
—
Lin reported from Sacramento. Associated Press writer Carla K. Johnson
in Chicago contributed to this report.
Follow Garance Burke at , Judy Lin at
and Carla K. Johnson at
From: Baghdasarian
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