On Language Access, Holding HHS Accountable to People, Not Insurance Companies

The Department of Health and Human Services (HHS) is currently creating the regulations that basically put the meat on the bones of this country’s health care reform law. It is the outcome of these rule-making decisions that will determine the success, or failure, of reform. NWFCO, with the Health Rights Organizing Project, has been weighing in on key aspects of reform that have been prioritized by the communities with which we work. One key issue is addressing the linguistic barriers limited English proficient (LEP) people face when trying to access health insurance coverage and medical care in the current system.

Almost nine percent of people U.S. are of limited English proficiency. For them, access to adequate interpretation and translation in the health care system is a matter of life and death. The new health care law recognizes this and presents opportunities for HHS to create strong rules to ensure linguistic access in both navigating state exchanges and private health insurance coverage and when receiving medical care. But, again, the standards must be high or they wonā€™t be worth the (non)translated paper they’re written on.

In September, HHS issued interim final rules for one piece of health reform ā€“ the insurance appeals process. These rules tell insurers when they must provide appeals-related interpretation and translation to their enrollees. Their first attempt at meeting the needs of LEP community members has fallen far short of adequate. The new rules let insurance companies off the hook for providing interpretation and translation in a number of important ways, such as:

  • Insurance companies can refuse to provide oral interpretation for an urgent health care decision within the 24-hour required time period.
  • Insurers don’t have to provide written translation for group plans if less than 10 percent (large plans) or 25 percent (small plans) of enrollees speak the same non-English language.
  • Insurers don’t have to provide written translation for individual plans if less than 10 percent of a county’s population speaks the same non-English language.

These rules are a boon to insurance companies who don’t want paying for language services to affect their bottom line. But the real bottom line is that people who don’t speak English deserve to be able to understand the health insurance they are purchasing. The federal government recognizes language access as a civil rights issue ā€“ insurers shouldn’t be given the go ahead to take those rights away in the pursuit of profit.

Everyone eligible for insurance needs to have a meaningful opportunity to enroll and use the benefits covered in the plan. At the very least, HHS should require that insurers provide:

  • For group plans, written translation when five percent of enrollees or 500 enrollees, whichever is lower, are literate in the same non-English language
  • For individual plans, written translation when five percent of a county’s population is literate in the same non-English language
  • Oral interpretation as needed by each enrollee
  • Clear information about the availability of interpretation and translation at no cost

We have a short window of time to improve this rule. HHS is accepting comments on language access comments until the end of this year. They are also holding regional meetings in Baltimore, San Francisco and Chicago between now and mid-November. NWFCO is working with partners in each area to develop events at these meetings that break through the bureaucracy of rule-making, call public attention to the role insurers play in erecting and maintaining language barriers, and put the heat on HHS to stand for people, not profit, and fix this feeble regulation.

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