Language barriers part of health exchange outreach

As health exchanges are implemented, language barriers become more of an issue in Washington and Oregon.

The Columbian

By Donna Gordon Blankenship, Associated Press

Monday, March 4, 2013


Source: The Associated Press

SEATTLE — A visit to a health clinic in Seattle’s International District, where patients speak more than 50 different languages, illustrates a challenge Washington faces as it launches its new health insurance exchange as part of the federal Affordable Care Act.

Officials have to overcome a language barrier with many people to get them to participate, a situation many who provide health services are familiar with.

“If the patient doesn’t understand and the provider doesn’t understand, you have great cause for problems,” said Teresita Batayola, CEO of International Community Health Services, which has four clinics around Seattle. Everyone on their medical staff speaks at least one language other than English. “Seattle happens to be very much an international gateway.”

The ICHS website is translated into four languages — Chinese, Korean, Vietnamese and Tagalog — and signage around the clinics is offered in multiple languages as well as symbols.

According to U.S. Census figures, nearly half a million Washington residents over age 5 speak a language other than English and say they don’t speak English very well.

More than 200,000 say Spanish is their primary language, but another 150,000 say they speak an Asian or Pacific Islander language, with Chinese, Korean, Tagalog and Russian the next most popular languages.

In all, people in Washington who don’t speak English well speak more than 150 different languages, not including dialects, according to the Census.

State officials estimate about 1 million Washington residents are uninsured, or about one in seven people who live in the state. About a third of them will likely become eligible for free health insurance under Medicaid if the Legislature votes to join the federal expansion program. The rest will be targeted by the state’s new health insurance exchange.

Reaching people like the users of the International District clinic — where only about 14 percent of the patients have private insurance — will be a challenge, acknowledged Michael Marchand, spokesman for Washington’s health plan finder.

The Affordable Care Act requires that Washington’s Health Benefit Exchange build relationships with local groups to help with outreach and assist people who need help signing up for insurance.

The Health Benefit Exchange will be asking groups to apply to be navigators and be paid to help people in their community navigate the exchange.

Chan Lai Ly came into the International District health clinic on Friday for a regular checkup for his diabetes. The 63-year-old exchanged information in both Chinese and Vietnamese with a medical assistant and a physician’s assistant.

Ly and his wife immigrated to Seattle two years ago from Ho Chi Minh City, Vietnam, to live near their children. When asked what he would do if he wasn’t able to get medical help in a language he understood, Ly shrugged his shoulders and said he would “give up.”

Marchand expects the navigator grants will go to larger community groups that will subcontract with organizations like International Community Health Services to reach specific populations.

The website for the insurance marketplace will launch in October in both English and Spanish, the most popular language in Washington other than English.

Developers of the website are still working on how they will let non-English speakers know they can get help on the telephone or in person in other languages.

And language barriers are not the only obstacle to getting everyone in Washington to sign up for health insurance.

“Part of the challenge is getting people to embrace change. Change is a difficult thing. There’s no way to really sugarcoat it,” Marchand said.

In Oregon

Oregon’s health insurance exchange will have staff who speak Spanish, Russian and Vietnamese to help explain and market the service that’s expected to provide health coverage to thousands of Oregonians.

The exchange will help the uninsured get access to health coverage once the federal health care overhaul requires most Americans to have insurance beginning next year.

But the state faces cultural and linguistic challenges in trying to educate limited-English speakers and hard-to-reach populations.

The exchange will be called Cover Oregon. Spokeswoman Lisa Morawski says staff will use an interpretation service to reach people who speak other languages. Cover Oregon also is partnering with insurance agents and community organizations to reach non-English speakers.

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Obama Asks Health Plans to Report Rising Rates


Published: March 3, 2013


WASHINGTON — The Obama administration says it will require health insurance companies to report all price increases, no matter how small, to the federal government so officials can monitor the impact of the new health care law and insurers’ compliance with it.

Under current rules, the federal government requires insurers to report information on rate increases of 10 percent or more. New rules being issued by the administration will extend this requirement to all rate increases for all health plans sold to individuals, families and small businesses — a total of 60 million people.

Federal health officials said they needed the additional data to monitor trends in premiums as major provisions of the law take effect and more people buy insurance.

“The purpose of this policy is to identify patterns that could indicate market disruption, which could occur given the additional standards that apply” to insurance starting next year, the administration said in a justification of the rules adopted by Kathleen Sebelius, the secretary of health and human services.

Under the new law, Ms. Sebelius said, she is supposed to “monitor premium increases of health insurance coverage” inside and outside the regulated state-level markets known as insurance exchanges.

Consumer advocates welcomed the new reporting requirements, saying they would enhance the ability of insurance regulators and the public to scrutinize rate increases.

Insurers object to the requirements. The federal government “is creating a hugely burdensome and expensive reporting system” that duplicates what most states already require, the Blue Cross and Blue Shield Association said.

The reporting requirements generally apply to rate increases sought after the beginning of next month.

A fierce debate has erupted over the impact of Mr. Obama’s health care law. Insurers and employers predict that it will drive up premiums, especially for healthy people under the age of 35. The White House disputes that prediction and says that many factors will lead to lower prices.

The law guarantees coverage for people regardless of pre-existing conditions, prohibits insurers from charging women more, and limits their ability to charge higher rates to older people.

Insurers now often divide consumers into groups. Premiums are often higher and rise faster for less healthy individuals and groups.

By contrast, the new law requires insurers to pool the claim costs of all their customers when setting rates in the individual market in a state. 

Likewise, insurers must consider the claims histories of all their small-business customers when setting rates for them. Premiums for each product are supposed to reflect the combined experience of all products in the market.

Federal health officials said they needed to know the prices of all insurance products so they could determine whether insurers were complying with these requirements.

If an insurer wants to increase rates for any product, it “must submit a rate filing justification for all products” in the same market, the rule says. “Products can no longer be reviewed as completely unique,” but must reflect the experience of the entire market.

Julia T. Philips, a health actuary who works for the Minnesota insurance commissioner, called this one of the law’s most important consumer protections. Minnesota has had a similar requirement for 20 years, she said, and consumers have benefited.

Insurers say that policies sold under the new federal law will be more comprehensive and more expensive than what many people have now.

The White House says the fears of “rate shock” are overblown. Consumers can move from expensive health plans to more efficient, lower-cost plans, the administration says. It says critics who focus on premiums do not take account of other provisions of the law that limit how much consumers will spend out of their own pockets for health care.

In addition, the administration predicts that people gaining insurance will, on average, be younger and healthier than those who already have it, and this would tend to hold down premiums. Finally, it says, even if premiums increase significantly, lower-income people will be able to get federal subsidies to help defray the cost.

Carmen L. Balber, the director of the Washington office of Consumer Watchdog, a nonprofit advocacy group, said: “We applaud the administration for the new reporting requirements. This is a huge step forward.” But she added: “There’s a loophole. In 10 to 15 states, insurance commissioners have no power to reject unreasonable rate increases.”

Representative Jan Schakowsky, Democrat of Illinois, said she would introduce a bill to provide the secretary of health and human services with power to deny or modify rate increases found to be excessive or unjustified. 


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