23 September 2013

Countdown to Health Care: Fighting for Equity for Women

By: Ellen Liu, Director of Women's Health for The Ms. Foundation for Women

There is a lot that organizations like Northwest Health Law Advocates (NoHLA) can do to make sure women are front and center in the Affordable Care Act, according to NoHLA’s Staff Attorney, Emily Brice. “More specifically, [we need to prioritize] women who are particularly vulnerable because they’re lower income, immigrants, have limited English proficiency, or who face other barriers to enrollment.” In Washington State, nearly one in five women between 19-64 years old is uninsured.

The Seattle, Washington-based organization is a Ms. Foundation grantee and works to increase access to health care and basic health care rights through legal and policy advocacy.

“We always knew that the federal government clearly cannot do this alone,” Health and Human Services Secretary Kathleen Sebelius recently told The Washington Post. While the Obama administration has highlighted aspects of the health care overhaul that are important to women — like preventive services without cost sharing and contraception coverage with no co-pays — current government outreach to support women’s enrollment in health coverage is limited, especially among the women who stand to benefit the most.

In Washington state, NoHLA and its network of partners have stepped in, pushing for greater equity in enrollment services ahead of the October 1st launch of the signup period for insurance plans in state marketplaces under the new law.

After learning from state officials that the Washington exchange would provide only very limited language access services — merely translating the state’s exchange website into Spanish — they “leapt into action and started doing education work,” Brice said. The effort, which began in December 2012, included raising awareness about the changing demographics in Washington state. In the past two decades alone, the number of limited English proficiency persons has risen 210 percent representing one of the fastest growth rates in the country. Spanish, Chinese, Vietnamese, Korean and Russian-speaking communities account for the highest numbers.

Of course, demographic shifts have become a national reality, as well. The Kaiser Commission on Medicaid and the Uninsured reports that as of 2009, approximately 21 percent of nonelderly people in the United States spoke a language other than English at home. People who identify as having limited English proficiency are uninsured at much higher rates than the rest of the population, at a staggering 50 percent.

Beyond demographics, it all comes down to a person’s right to health. The ACA prohibits discrimination on the grounds of race, color and national origin for any health program or activity receiving government funding and for any plan offered through the new ACA insurance marketplaces. This requirement was derived from Title VI of the historic Civil Rights Act, and was bolstered in 2000 by President Clinton's Executive Order 13166 to improve access to services for individuals with limited English proficiency.

NoHLA’s pioneering initiative invoked the legal requirements for Washington state to provide language-access services. As a result of the ongoing negotiation process, today, the Washington exchange has agreed to translate the enrollment application and other key materials immediately into eight languages, and into every other language as needed by individual clients. It will provide oral interpretation services in more than 150 languages, as well as offer relay services and other key services for those who are deaf or hard of hearing. Washington has now become a leader in language-access services and an example for other state exchanges.

In addition to language access, there were concerns about cultural competency and sensitivity in outreach, or “what we call ‘plain talk’ here in Washington State,” Brice explained. “Are the materials that are being distributed understandable for someone with a 6th grade education? Are they written in a way that regular people can access?”

Expanding access to care also means an expanded need to improve health care literacy. “Folks who have never before been able to access insurance coverage need to be able to learn how to use it,” Brice said.

NoHLA’s solution to making sure these important concerns become institutionalized was advocating for the creation of a Health Equity technical advisory committee, appointed by the state’s health Exchange Board and charged with considering issues of health literacy, cultural competency and hard-to-reach populations. Currently, NoHLA works closely with members of the committee to advocate for joint goals in overcoming access and enrollment barriers.

Thanks to NoHLA and its partners, Washington women will experience a considerably easier process of enrollment that is culturally sensitive, produces materials in their appropriate language and demystifies complicated health care terminology.

But the goal is not simply higher rates of women’s enrollment; it’s the improved health outcomes of thousands of Washington women previously denied that opportunity.

The Ms. Foundation is proud to support pioneering leaders like NoHLA as they eliminate barriers for women, fight discrimination and ensure that affordable, quality health care is not a privilege but a basic human right for all.


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