Translating Rights into Access: Language Access and the Affordable Care Act

Abstract

More than twenty-four million people in the United States are considered limited English proficient (LEP), and numerous studies have documented the consequences of communication barriers in healthcare. These consequences include: patients’ inability to become engaged and involved in their care; the absence of crucial information—including cultural information—essential to healthcare quality; risks to patient safety arising from the misunderstanding of physician instructions; and ethical and legal lapses stemming from the absence of informed consent. Addressing healthcare rights necessarily entails coming to grips with how to facilitate communication and the exchange of information between the healthcare system and an increasingly diverse patient population.The history of language access services in healthcare is grounded in two distinct bodies of law: the law of informed consent and civil rights law. Modern notions of informed consent law—which have their roots in the Nuremberg trials of the late 1940s—would recognize a cause of action in tort where a lack of adequate communication creates a barrier to an LEP patient's ability to consent to care. In modern healthcare law, the ability of patients to affirmatively give informed consent to treatment is considered a fundamental element of healthcare quality.

Including Language Access into Medicaid ACO Design

“…24 A number of civil legal cases allege that professionals failed to provide deaf patients with language services. 25 Though the available health care and language access research includes LEP and deaf individuals on Medicaid, research studies almost always group those Medicaid members with individuals on other health insurance. We only found a few studies that looked at language barriers specifically for Medicaid members.…”

The Right to Language

“…Indeed, the various statutes related to health care are founded on patient communication; effective communication allows access to important health information. In particular, “…the ACA treats language access as a foundational element of high quality healthcare.” 47 Hence, these laws recognize the right to language, regardless of its modality.…”

“…In particular, "…the ACA treats language access as a foundational element of high quality healthcare." 47 Hence, these laws recognize the right to language, regardless of its modality.…”

An Online Training to Prepare Occupational Therapy Students to Work with Clients with Limited English Proficiency and Interpreters

“…Language access (provision of appropriate interpretation and/or translation services) in healthcare is mandated by Title VI of the Civil Rights Act of 1964. Title VI applies to all healthcare entities that accept federal funding, including any site or provider who accepts Medicare, Medicaid, Children's Health Insurance Program (CHIP), or federal grants (Teitelbaum, Cartwright-Smith, & Rosenbaum, 2012). Additional legislation also requires or encourages language access in healthcare, including the Hospital Survey and Construction Act, the Emergency Medical Treatment and Labor Act, and state legislation in several states (Mirza & Harrison, 2018;Teitelbaum et al, 2012).…”

“…Clients with LEP who are not provided with interpreters are also at higher risk for readmissions and longer lengths of stay (Lindholm, Hargraves, Ferguson, & Reed, 2012). In addition, such clients are less likely to receive client-centered care, have poorer compliance with follow-up care and recommendations, and report decreased satisfaction (Bender, 2002;Jacobs et al, 2003;Karliner et al, 2007;Teitelbaum et al, 2012). Fortunately, the use of professional interpreters has been shown to improve patient care to a level near or equal to the quality of care for English-speaking clients (Jacobs et al, 2003;Karliner et al, 2007).…”