As of 2009, approximately 9% of the non-elderly US population (~21 million) was identified as having a limited English proficiency (LEP). Hispanics account for two-thirds of the LEP population and Asians account for 18%. Reflecting this racial and ethnic mix, 14.4 million LEP individuals speak Spanish at home, while 1.1 million speak Chinese, and 1.7 million speak Vietnamese, Hindi, or Korean. Nearly half of adults with LEP are uninsured – nearly three times the uninsured rate of English proficient adults. Individuals with LEP often face multiple barriers in accessing coverage and health care, ranging from the language proficiency itself to poverty and low education. Under the Patient Protection and Affordable Care Act (PPACA or ‘Obamacare’), approximately thirty-two million uninsured Americans will have access to health insurance. Medicaid will expand to nearly all individuals with incomes up to 133% of poverty. In addition, individuals without employer coverage will be able to buy insurance through new health exchanges and those with incomes up to 400% of poverty will be eligible for advanced tax credits to help pay for coverage. About 95% of uninsured individuals with LEP have incomes below 400% of poverty, meaning that they will be income-eligible for Medicaid or Exchange subsidies in 2014. Therefore, newly enrolled LEP individuals will likely require assistance navigating the health care system. Given these needs, it is imperative for community based organizations and safety-net providers to have a full complement of language services available if they are going to adequately meet the demands of increasing numbers of LEP patients within the health care system.
ACA coverage expansion will provide new coverage options for many individuals with LEP. However, to truly achieve the goals of the law of reducing health care cost while improving access and quality, it will be essential for health care organizations to provide effective and efficient range of tools to the provider and the consumer - tools that will facilitate seamless interactions.
Satjiv S. Kohli M.D., M.B.A