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Language Barriers Persist in Affordable Care Act Enrollment

Experts say language remains the biggest barrier for Asian Americans and Pacific Islanders attempting to enroll in the Affordable Care Act.
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It took 70 community groups working across 22 states in 41 languages to help 600,00 Asian Americans and Pacific Islanders (AAPIs) navigate the first open enrollment period for the Affordable Care Act in 2014. This year, experts say many of the same issues persist, and language remains their biggest obstacle.

“Even in the second enrollment cycle, Asian Americans (AAs) and Native Hawaiians and Pacific Islanders (NHPIs) continue to face enrollment barriers to the ACA,” said Isha Weerasinghe, Senior Policy Analyst at Association of Asian Pacific Community Health Organizations (AAPCHO), “With 32% of AAs being Limited English Proficient, and 29% of Pacific Islanders speaking a language other than English at home, the need for in-language resources and assistance is great. Additionally, some AAs and NHPIs have low health literacy, and some may not be aware of how immigration verification can affect one’s coverage.”

“In the first enrollment, we had NO support or resources in terms of bilingual navigator assistance for the Asian-American community,” says Dr. Tsu-Yin Wu, Director of Michigan’s only AHJ member Healthy Asian Americans Project (HAAP). But this year, she received a federal grant to hire additional help, and is hiring bilingual navigators who speak Mandarin/Cantonese, Bengali, Vietnamese, Tagalog, Hindi, and Gujarati.

Some of the challenges faced during the first Open Enrollment Period—such as lack of culturally and linguistically appropriate materials, insufficient and unequal distribution of resources, low health literacy, and immigration-related concerns—persist, but the learned experiences, a new best practices guide, and a new multilingual glossary help considerably as the second Open Enrollment period begins.

Still, organizations warn that it's not just language translation that's needed.

“We know that many Asian Americans immigrated from health care systems very different from the U.S.,” said Wu. “Therefore, insurance terminology makes no sense to them, for example, co-pay, deductible, et cetera...Low health literacy means we have a long way to go.”