BY HILARY ABRAMSON
New American Media
At dawn an elderly Chinese-American woman fiddles with her cell phone at a bus stop, headed for the L.A. county hospital. Cancer is the second thing on her mind.
She thinks about the early years, when she took along her neighbor’s 14-year-old son to interpret. She still pictures the way he would turn his back while she exposed what was left of her breast for the doctor. The boy’s vocabulary was limited, and to this day she doesn’t understand at what stage her cancer went into remission.
Seven years of commuting for treatment and follow-up have failed to diminish her anxieties. What if she has to sit around feeling sick and isolated in the outpatient clinic all day again? What if she misses her appointment because they mispronounce her name again, and she has to wait for later buses that take more than two hours to take her home?
There are more than 2 million people in the United States like Yong Nan Wu, according to the U.S. Census. They speak English poorly, or not at all. And although they are covered by Medicare, it does not pay for medical interpreting, exposing them to medical errors and hospitals to unnecessary costs for tests and emergency room visits.
This could be reversed, according to a new report that details how Medicare could pay for medical interpreting, but stops short of estimating how much the coverage would cost. The report, titled “Paying for Language Services in Medicare: Preliminary Options and Recommendations,” is self-described as “a starting point” for a national conversation about adding this coverage to Medicare law. It was funded by the California Endowment and produced by the Center on Budget and Policy Priorities with oversight by the National Health Law Program (NHelp).
Banking on a change of Congressional heart regarding federal entitlement spending, a working group representing 70 organizations that deal with language barriers in health care is drafting legislation for Medicare to enable doctor-patient communication.
Congressional Republicans with power over changing Medicare law either duck the question or ask for more study.
Rep. Bill Thomas (R-Calif.) chairs the House Ways and Means Committee, which oversees Medicare. According to his spokesperson, Ianthe Jackson, he declines comment on the proposal. “He tends not to deal in hypotheticals,” Jackson says. “A pretty liberal group put out the report and I tend not to track what it puts out.”
Sen. Charles Grassley (R-Iowa) chairs the Senate Finance Committee that oversees Medicare. “We do not know for certain if medical interpreting would improve health outcomes for seniors,” says Jill Gerber, his spokesperson. “Before we make any potentially quite expensive changes to our already unsustainable entitlement programs, we need to make fairly certain these changes will result in improved health outcomes. This proposal needs more study and analysis.”
Mara Youdelman, the NHelp attorney who co-directed the report project, measures her response to Grassley’s hesitancy.
“Significant research documents the improved quality of care that occurs when patients and providers understand each other,” she says. “Providing interpreters can reduce medical errors, improve compliance with treatment, prevent complications, and reduce unnecessary tests and visits to the emergency room.”
Failing to provide free medical interpreting is considered a form of discrimination on the basis of national origin, according to the Title VI of the 1963 Civil Rights Act. Every medical entity receiving federal funds is mandated to provide patients with free interpreting. But few of the estimated 20 million limited-English-proficient (LEP) residents in the United States are lucky enough to receive interpreting from a trained medical interpreter, someone who knows medical terminology and understands patient confidentiality.
When it comes to paying for medical interpreting for young and old patients, everyone passes the buck. Insurance companies rarely pay for it. Most hospitals use untrained, bilingual employees performing other jobs, or expensive telephonic language services that do not work in all medical situations. Only 3 percent of hospitals get reimbursed (primarily through state Medicaid programs) for language-access costs, according to the report. And only 13 states have applied for and received federal matching funds of 50 percent or more for medical interpreting from Medicaid and the federal insurance program for poor children.
“The Medicare program has agreed to pay for costly implantable defibrillators, after determining these devices were effective in improving health, despite the cost,” writes author Leighton Ku, research fellow at the Center on Budget and Policy Priorities. “Surely the nation could make similar reforms to Medicare to increase the quality of language services for limited-English-proficient (LEP) Medicare beneficiaries.”
According to the report, 46 percent of elderly LEP seniors are U.S. citizens. Although the majority are immigrants — naturalized citizens and non-citizens — a large number are native-born American citizens who are LEP. About half are Spanish-speaking.
To qualify for Medicare, a person must be a U.S. citizen or a legal non-citizen immigrant who has met additional criteria. Most foreign-born Medicare beneficiaries had to work in the United States for more than 10 years in order to qualify, or their spouses had to work that long.
Solving the dangerous problem of language barriers in health care will take more than funding, says Ignatius Bau, director of Culturally Competent Health Systems for The California Endowment. “We realize that it will require a combination of systems and people — video and telephonic conferencing, bilingual providers, and certified medical interpreters.”
As for Yong Nan Wu, she is luckier than the millions of LEP patients her age who wonder whether they will ever understand their health care providers. Born in Shanghai and married to an engineer 52 years ago in Beijing, she moved with her husband to live with their youngest daughter in Los Angeles in 1997. Two years later, Mrs. Wu received her green card. Last year, she became a U.S. citizen.
Four years ago — after three years without medical interpreting and confusion and worry over medical misunderstandings — she noticed a Chinese patient who arrived at the hospital with her very own interpreter. Since then, Mrs. Wu has had her own interpreter, thanks to PALS for Health — the only nonprofit program offering free, trained, medical interpreters to patients in Los Angeles and Orange counties.
“Today, my big fear is if my interpreter has to cancel,” she says. “Without her, I have no faith I am safe in this system.”
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