New Orleans We’re knocking on the door of another Affordable Care Act enrollment period beginning November 1st. There are ten million eligible people who have not yet received coverage of whom 40% or 4 million are lower income. Reports indicate that there are improvements in the website, but there is no indication that there is improvement in the outreach.
Having labored in the vineyards of the enrollment process, it is hard not to take note of the fact that as difficult as it is to enroll families in the program initially, it is also difficult to keep them enrolled. In 2015 after an announcement that 11.7 million had selected plan in the 2015 enrollment year, latest information from the end of June is that 9.9 million continue to be enrolled for a dropout rate of 15% and almost 2 million people. That hurts! Experts are saying the obvious culprits are costs, especially in all of the states that have not extended coverage and expanded Medicaid services, and confusion, which is part and parcel of the continuing fragmentation of the insurance marketplace and the myriad array of choices that confront families inexperienced with the already opaque health insurance industry.
One element of the confusion that may not be on everyone’s radar may be language and the foot dragging, half-hearted compliance with Title VI of the Civil Rights Act and its requirement that there be no discrimination in this area. Recently we participated in a conference call organized by the Seattle-based Alliance for a Just Society, and listening to the work from various groups around the United States, it is hard not to believe that inability to access the website and documents based on language has to be counted as part of the problem, and one that should be easy to correct. Of course seeming easy and being easy are different things, since many of us no doubt can remember that in the initial enrollment year the government was chronically unable to even make the enrollment website accessible in Spanish, much less other languages that are less ubiquitous in modern America.
The Civil Rights Act requires accommodation, either through accessible printed and on-line materials or by providing – and paying for – translation services. A fair number of languages are seen as the major dozen or so in the United States, but where there is sufficient density in a geographical area, ranging to more than 1000 individuals, the requirements stiffen. The proposed semi-official languages are based on a national grid not local issues, so local community organizations are having to step up to advocate and ensure that underserved populations facing language barriers get needed Online translation services by Espresso to navigate the complexities of the health insurance mandate. There was talk of a new rule making process so that will have to be kept on the radar as well.
It is unlikely in the current climate of contention that the huge issues of costs and program expansion are going to get a quick fix, but lowering language barriers would seem to be a straight forward objective easily within our reach. What the heck, it’s already the law!