Lost in Translation: Part Three, “The Carrot and the Stick: My Year With Obamacare”

The 2016 Open Enrollment has ended, and (finally!) the Get Covered Illinois commercials are becoming fewer and further between . . . even on my own DVR backlog of the past few months’ television.

But public and political dialogue about the ACA and its impact is far from over.  As we gear up for this year’s presidential election, we’ll be hearing much more (from both sides of the aisle).

Interestingly enough, below the cut, in Part Three of our series, “The Carrot and the Stick: My Year With Obamacare,” we’ll explore how healthcare reform dovetailed neatly with another of this election season’s ‘hot button’ political issues: immigrant rights.

Let’s begin by taking a closer look at just one example of the stark contrast between Obamacare’s ‘on paper’ plan and its practical outcomes: ESL-consumer accommodations.

From our ‘Navigator’ manual:

2.1 Customer Service Guidelines

Your goal is to provide consumers with friendly and impartial customer service that meets their needs.  Customer service includes the following:

•Making customers feel welcome, important, heard, and respected by responding to their requests.

•Communicating in a way that supports consumers’ understanding and needs

•Assisting consumers in a culturally-sensitive manner, using language translation services as appropriate

•Responding appropriately to consumers’ needs and accommodation requests in a timely manner

•Referring customers to other entities when their needs cannot be met by the Navigator program

As one continues to read through the manual, these bullet points are further illuminated by entreaties like “consumers’ friends and family may serve as interpreters only at consumers’ requests.”

But our manual served much more as a suggestion box of best practices than codified requirements for service.

ff16b53608b67e6cb3a477d80339043eHowever, in the quarterly progress reports that each CMS-grantee (in this case, the Lake County Health Department) was sending along to the Marketplace team for evaluation, we did have specific benchmarks we were required to meet.  And, unless I was missing something, here was where we were really flailing.

Among the information collected in these quarterly reports would be:

•“An estimate of the consumers who were referred to a program providing consumer assistance for further help after enrollment is complete (e.g. — Refer consumers to the State Department of Insurance to address their complaints against an insurance company)

•“Provide at least one example of how the grantee avoids conflicts of interest.”

•“Describe in detail how the grantee is meeting privacy and security standards and whether the grantee has experienced any security breaches during the quarter. (Note: You must report all security breaches to HHS immediately).

Likewise, as part of these quarterly progress reports the federal and state governments required grantees under the Navigator program to submit, details of adherence to CLAS (or Culturally and Linguistically Appropriate Standards) were requested:

Provide at least one example of how the grantee adheres to CLAS standards, including:

Plans to address consumers translation needs

Number of consumers assisted whose primary language was not English

The top five primary languages of consumers who have received assistance from the grantee

Now, the LCHD was indeed the main grantee (with the ultimate, final responsibility for enforcing adherence to policy among its sub-grantees) and its physical clinics themselves had access to the AT&T Language Line (which is a paid translation service wherein a social service worker can call the Language Line, request a translator, and this person (a real human!) will stay on the phone with them for the duration of the appointment with the client). 

But since us on Enroll Lake County’s ‘Central Team’ were never “technically” LCHD employees, we groped around blind with none of these same tools available.

Though in most of our outreach communities, the bilingual needs were for Spanish-language speakers, a number of Asian-American and Polish immigrant families were also experiencing language barriers when seeking out social services.

Among my many experiences with clients with limited English proficiency, I had:

1.) A daughter, a practicing physician who still had spent months wading through Healthcare.gov before coming into my office (as a referral from her congressional representative) speaking Hindi for her parents who knew enough English to smile and call me “Miss Ann,”

2.) A fifteen-year-old son, who in his fugue of puberty, valiantly struggled to divide his attention between answering the application questions on behalf of his father and staring at my breasts,

3.) A forty-something mom, the approved representative of her 80-something mother, who spoke exclusively Cantonese,

4.) . . . and so many more.

Most of the time, if a client was non-Spanish speaking, but also limited in their English proficiency, they would bring along a child or friend to their appointment: as if they anticipated our unreadiness to serve.  I vacillated between feeling guilty that Enroll Lake County could only provide dual-language services in Spanish and my parents’ more conservative voices in my head whispering that it wasn’t the government’s responsibility to hand everything out on a silver platter.

But it was not just my parents who felt that way, and their opinions were echoed in the most unlikely of places.

When the RFI (request for information: basically, a form to give us your contact information at an outreach event where we didn’t have time to meet with you individually) cards arrived from the state, they came in only English — not double-sided English/Spanish like we had come to expect from official forms and signage. 

As us gringas complained away about the ‘insensitivity’ of such an oversight, Claudia, a woman raised by first-generation Hispanic immigrants and so socially-active and well put-together that you simply looked at her and saw the first female president of America, spit out, “Latinos don’t need everything done for them!”

And just like that, all our white privilege guilt was shaken.  As one of Mom’s home-care nurses, Sofia, commented after we expressed our sadness that none of her grandchildren speak Spanish, “if you live in America, you should be American.”

Yet, placing this more in-depth philosophical debates aside for the time being, the promise for language accommodation was made and then broken. 


Courtesy of Flickr user rudy.kleysteuber.  The Spanish word “exito” does not mean “exit,” but rather “success.”  So, if you were looking for your big break, apparently it’s in line at a New Jersey Starbucks.

The translation quality for the Spanish-language versions of each of the websites we used: the federally-based Healthcare.gov, and the state-based GetCoveredIL.gov and ABE.Illinois.gov was seriously lacking. 

It was as if a high-school Spanish student had taken the English text and popped it directly into Google Translate.

In fact, as an experiment, Linda and I tried just that. 

And, low and behold, copying and pasting sections of the English-language Healthcare.gov site into Google Translate produced a word-for-word facsimile of what was being used on the Spanish-language version of the site.

When Spanish-language forms finally did arrive from the State, they were riddled with typos and strange translation choices that may have been correct in denotation but certainly were not in connotation. 

For example, the flyer we were sent in June to distribute for Illinois’ newly-legalized same-sex marriages (marriage is a ‘qualifying event’ in which you have options for enrolling in insurance outside of Open Enrollment) used the phrase, “cuidase.”

The English equivalent was intended to be “cover yourself,” as in with a health insurance plan.  The Spanish connotation of that phrase, however, is “take cover!,” as in a 1960s child hiding under his desk from a rain of Red commie bombs.

Since I was the one tasked with creating a spreadsheet of languages spoken by all 80 of our navigators, I know for a fact that, not only are most of the 80 not bilingual at all, but other than Spanish, the sole other language on offer was (by request only) American Sign Language.

And surprise, surprise, LCHD’s ‘central team’ had forgot to hire any fluent Spanish speakers beyond Linda . . . therefore, my skills (which I had emphasized in my interview were strictly conversational-level) were stretched to the maximum.

All of which is to say that maintaining a healthy dose of suspicion towards policy decisions built upon a pile of rhetoric is always a good idea.  This is especially pressing during an election season . . . when oversimplifications buzz around us like so many flies — creating a cacophony of sound that easily drowns out intelligent discourse.


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