Diversity and the Affordable Care Act

The Patient Protection and Affordable Care Act is a long and complex piece of legislation that attempts to reform healthcare by providing quality health insurance and curbing the growth in healthcare spending in the U.S. The reform includes new benefits, rights and protections, rules for insurance companies, taxes, tax breaks, funding, spending and new job creation.

Language Barriers

Language barriers are and have been a significant challenge in implementing the Affordable Care Act (ACA). In some states, as many as 7 million people are considered Limited English Proficient (LEP). These LEP individuals have fewer resources to  interpret and understand the benefits of the ACA. It is estimated that only 46 percent of LEP individuals will enroll in the healthcare plan because of this language barrier. In light of these challenges, many states created training modules to help with translation of the ACA and to booster enrollment and understanding. Likewise, many employers and healthcare providers are working to translate documents, utilize interpreters, and conduct remote and on-site interpretation.

Health Insurance Exchanges

Data and research demonstrate extensive disparities in access to, quality, and outcomes of care for racially, ethnically, and linguistically diverse patients and communities. The ACA includes several provisions intended to close the gaps. The new law provides incentives and requirements to create a more equitable healthcare system by expanding the number of healthcare settings closer to where people live and work, increasing diversity among healthcare professionals, and addressing language and culture in delivery of services.

An integral part of the ACA is the creation of health insurance exchanges or marketplaces that offer access to health insurance. These exchanges can be operated by the state, the federal government, or a combination of both. Both state and federal governments are working to provide exchanges with information that is culturally and linguistically appropriate and meets the standards set forth in the ACA.

Exchanges must meet the needs of racially and ethnically diverse populations as they are predicted to have higher percentages of diverse individuals enrolling as compared to traditional employer-based insurance. By 2019, an estimated 29 million people will have insurance through the exchanges, 42 percent of those are projected to be non-white. The ACA requires every exchange to have a navigator program to assist consumers and provide information that is culturally and linguistically appropriate. In many states, the navigator program is a network of nonprofit organizations and local agencies that will help find potential exchange members and sign them up for insurance.

In addition to the navigator program, there are many examples of other programs being implemented by states and organizations to assist non-English speaking individuals to obtain better healthcare. California’s Medicaid program has identified 13 threshold languages and if the number of enrollees speaking a threshold language reaches a certain level, the organization will translate documents into that language.

Maryland passed legislation that establishes Health Enterprise Zones to offer incentives to providers for serving the population in underserved areas, improves racial and ethnic data tracking, sets standards for provider cultural competency training, and creates the Maryland Health Innovation Prize to encourage innovative ideas and strategies to reduce health disparities.

In New York, an Executive Order requires all state agencies to provide free language interpretation in six languages, in addition to English. The New York Exchange has also expanded a call center to provide assistance with healthcare applications, answers questions about benefits, and helps people find out whether they qualify for coverage. The center can also make referrals to enrollment facilitators if individuals need help applying for health coverage.