Testimony of NHeLP’s Mara Youdelman Before the Congressional Asian Pacific American Caucus

Thank you, members of the Caucus, for holding this important hearing. As a staff attorney working on civil rights issues, and particularly language access issues, I welcome the opportunity to speak with you this afternoon on behalf of the National Health Law Program. I look forward to discussing measures for the Caucus and Congress to improve language services.

As my organization focuses on health care issues primarily affecting individuals of limited incomes, my testimony will concentrate on issues of language access in the public health programs. We believe special attention should focus on language services in health care for individuals with limited English proficiency (LEP). [1] These services promote access to and quality of care in health care, which is a crucial ? and sometimes life-or-death ? issue, affecting everyone throughout their lives.

We would ask the Caucus to consider three issues:

1. Increasing the federal “match” for language services provided to Medicaid and State Children’s Health Insurance Program enrollees to 90%.

2. Authorizing and appropriating funds for HHS to establish a national toll-free 24-hour-a-day “language line” so that all CMS grantees and providers can access interpreter services for their patients/clients, including providers offering services to Medicaid, Medicare and State Children’s Health Insurance enrollees.

3. Mandating the collection of racial, ethnic and primary language data throughout HHS health programs to assist in identification of and targeted assistance to address disparities in access to and quality of health care.

Background

The need for language services is well-documented, most recently by the 2000 Census. Over 1 / 21Testimony of NHeLP’s Mara Youdelman Before the Congressional Asian Pacific American Caucus 21 million Americans speak English less than “very well.” And 22.5 % of Asian and Pacific Islander speakers speak English “not well” or “not at all.” Much research has documented the health disparities in access, treatment and outcomes that can arise due not only to race and ethnicity but also language. As documented in the Institute of Medicine’s (IOM) recent report entitled “Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care”, [2] lan guage barriers pose a problem for patients where health systems lack the resources, knowledge or institutional priority to provide interpretation and translation services. According to the IOM, “[l]anguage barriers may affect the delivery of adequate care through the poor exchange of information, poor shared decision making, or ethnical compromises (e.g., difficulty in obtaining informed consent [citation omitted]).” The report recommended supporting the use of interpretation services when community needs exist.

Further, a recent report from The Access Project compared the experiences of uninsured individuals receiving care at hospitals across the country in three groups: 1. those who did not need interpreters; 2. those who needed and received interpreters; and 3. those who needed but did not receive interpreters. The survey found that 27% of those who needed but did not get an interpreter said they did not understand the instructions for taking prescribed medications, compared to only 2% of those who either got an interpreter or did not need one. The report also documents that individuals needing but not receiving an interpreter were less likely to be offered information about paying for their medical care, were more likely to say they would not seek care at a particular facility because of their health care debt, and would not use the hospital even if they became insured. [3]

And a recent study documented the potential adverse consequences of using untrained interpreters. In pediatric emergency rooms, researchers evaluated usage of professionally-trained interpreters, “ad hoc” interpreters (e.g. friends, relatives, children, untrained staff or strangers from the waiting room) and no interpreter. Overall, eighteen percent of interpretation errors had potential adverse medical consequences for patients. For example, in one case a family thought they should give their child two tablespoons instead of two teaspoons of a medication and they failed to understand that a second medication was to be given. But the rate of errors of potential medical consequence was significantly lower for those encounters using a professional hospital interpreter ? about 12 percent ? as compared to those using an ad hoc interpreter ? 22 percent ? and those using no interpreter ? 20 percent. [4]