Lack of Asian-language materials on exchanges leaves many AAPIs uninsured, say advocates

The lack of Asian-language materials on health care exchanges has left hundreds of thousands of Asian Americans, Native Hawaiians and Pacific Islanders uninsured, according to a report released last month by Action for Health Justice (AHJ).

“Sixty percent of our population are foreign-born and face language barriers and are in a range of immigration statuses,” notes Doreena Wong, project director of Asian Americans Advancing Justice – Los Angeles’ Health Access Project, one of 70 community-based organizations and federally qualified health centers that are a part of AHJ. Yet, she says, “Very little, if any, resources were directed to our communities. We were not given in-person assistance funds and many of our groups didn’t receive navigator funds.”

With federal and many state governments continuing to provide outreach materials almost exclusively in English and Spanish, Asian American, Native Hawaiian and Pacific Islander communities are likely to once again face enrollment barriers during the second Open Enrollment period that starts in six weeks.

The 2010 passage of the federal Affordable Care Act, known as Obamacare, offered a chance for many of the estimated 50 million uninsured Americans to have access to health care. One of the gateways to obtaining coverage was through the establishment of online marketplace exchanges where people could buy affordable health care. 

States were given the option of setting up their own marketplaces, or having the federal government step in to do it. There are currently 17 state-based marketplaces, including one in California, and 27 federally-run marketplaces, with seven run jointly by the state and federal governments.

Most of the federal and state-based marketplaces provide enrollment materials almost exclusively in English and Spanish. Covered California, the state’s health insurance exchange, includes informational materials in Chinese, Korean and Vietnamese. 

Dana Howard, Covered California’s deputy director of communications, maintained that based on feedback the exchange has got, most non-English speaking consumers “are not inclined to do online enrollment.”  For them, help is available through certified enrollment counselors hired by community-based organizations and insurance agents, he said. The state’s exchange has provided money for this.

An estimated 1.9 million Asian Americans, Native Hawaiians and Pacific Islanders were uninsured before Open Enrollment began last year. Wong and other health care advocates could not tell how many are still uninsured, citing difficulty in tracking. However, advocates say more than 200,000 people contacted nonprofit groups in AHJ’s network that serve the AAPI community to get help to buy health insurance at the close of the first open enrollment period. They say waitlists for assistance were very long, and advocates could not call back everyone who needed help to enroll.

The AHJ report found that not enough has been done to give these communities access to the information they needed to sign up. The report found that the marketplaces “fell short of servicing (limited English proficiency) and immigrant consumers.” 

HealthCare.gov Criticized

The report also criticized the federal government Website, HealthCare.gov, for posting limited resources and only in a few Asian languages. “Consumers were further confused by the list of in-language materials for in-person assisters on marketplace.cms.gov not matching those on HealthCare.gov,” the report said. In California, the state marketplace’s translated materials were too technical for many consumers to understand, Wong said.

For example, Korean translations of materials provided on HealthCare.gov “contained phonetic translations of health insurance marketplace terms that lacked functional meaning.”

AHJ was formed in July 2013 to outreach to Asian American, Native Hawaiian and Pacific Islander communities, especially those who are low income, have limited English proficiency or are in mixed immigration status families. The national network has succeeded in contacting some 600,000 un-enrolled people. But Priscilla Huang, senior director of impact with the Asian and Pacific Islander American Health Forum in Washington, D.C., one of four national AHJ partners overseeing the network, said there was no way to track how many of them enrolled, but many who sought help from their partners were still uninsured when Open Enrollment ended.

Huang worries that with the second Open Enrollment period just around the corner, the challenges for community-based organizations working with the AA and NHPI communities will be even greater this time around, given that people renewing their coverage, as well as first time enrollees, will have only a three-month window to enroll. During the first Open Enrollment, they were given six months.

Complaint Filed Citing Discrimination

Attorneys with the National Immigration Law Center (NILC) and the law firm Holland & Knight joined health care advocates in Pennsylvania and Illinois to file administrative complaints with the Office of Civil Rights (on Sept. 30), contending that recent termination of health insurance policies were sent only in English or Spanish, in violation of the anti-discrimination provisions of the ACA.

“The language you speak, the money in your pocket, or your zip code shouldn’t determine whether or not you have access to affordable health care,” said Marielena Hincapié, executive director of the National Immigration Law Center, in a press release. “Unfortunately, these factors will result in a loss of coverage for immigrant families who don’t speak English or Spanish and did not receive meaningful notice from the federal government. We will continue to fight to ensure that these people aren’t living one accident or illness away from bankruptcy.”

They also filed a Freedom of Information Act request to determine why an estimated 115,000 people who had bought health coverage through the exchanges were notified earlier this month that they had not provided sufficient proof of their immigration or citizenship status.

Health and Human Services officials have struggled for months to verify the immigration or citizenship status for many who bought insurance under Obamacare. In August, the department sent notices to more than 300,000 families informing them that they needed to resubmit information verifying their eligibility to purchase health insurance through the federal marketplace. According to advocates, many of these individuals had already submitted paperwork several times, causing growing frustration for health care applicants.

“Part of what makes this problem so discouraging to consumers is that it was completely preventable,” said Thoai Nguyen, CEO of Southeast Asian Mutual Assistance Associations Coalition (SEAMAAC), which helped Asian immigrants with their health insurance applications. “Had the marketplace communicated with consumers in a language they understand, many of the families would have been able to realize the urgency of these notices and respond promptly.”

The Centers for Medicare and Medicaid Services did not respond to calls for comment.