A federal law aimed at protecting civil rights asserts that healthcare organizations must provide limited-English patients and beneficiaries with written communication notifying them of free language-access services.

The Trump administration wants to remove this and other related regulations, including eliminating the requirement that limited-English patients be given directions on how to report discrimination.

The administration’s stated rationale for the changes to these laws, which are established under Section 1557 of the Affordable Care Act, is to save money for healthcare providers, insurers, and pharmacy benefit managers. 

The proposed rule also takes away the requirement for the Office of Civil Rights to weigh the presence or absence of effective language-access plans. In addition, it wants to eliminate current video remote interpreting standards.

These changes are part of a broader proposed regulation that would roll back numerous civil rights protections. A public comment period will remain open until  Aug. 13.

The proposal would not change the government’s requirements that insurers and medical facilities provide meaningful access to language services for limited-English speakers, as well as the Deaf and Hard of Hearing.

According to a summary provided by Kaiser News, the administration does acknowledge the change would lead to fewer limited-English citizens accessing health care, as well as fewer reports of discrimination. But it also questions the need for these notices, pointing out that in some areas health organizations spend significant dollars to accommodate a small number of limited-English speakers.

In all, the administration said the impact of rolling back these requirements would be “negligible.”

Civil Rights Advocates Disagree

“I haven’t seen any reason to believe that this will only have a negligible impact,” said Mara Youdelman, managing attorney for the Washington, D.C. office of the National Health Law Program (NHeLP), a civil rights advocacy group. She told NBC News the proposal “will likely result in people just not knowing their rights (and) not accessing health care.”

An estimated 25 million people in the U.S. are limited English proficient (LEP), according to the Census Bureau. This means they are entitled to language assistance when seeking health care under Section 1557. Patients facing language barriers have a higher risk of health care complications because they may misunderstand a doctor’s instructions.

A statement on NHeLP’s website reads, “Opening the door to discrimination in our healthcare system is no way to ensure equal access to vital healthcare coverage or to plan for our country’s future.  We should be building on the progress we made in the Affordable Care Act (ACA) in making health care available to more people; in ensuring that LEP individuals can understand their healthcare options; and in specifically prohibiting healthcare discrimination on the basis of race, ethnicity, immigration status, (or) disability. This administration is doing exactly the opposite.” 

“(If the proposal is adopted) more patients would not understand information involving their health,” Katie Keith, a Georgetown University professor who specializes in the ACA, told NBC News. “Some of these details on insurance and billing documents are already difficult for native English speakers to decipher and could be a challenge for less fluent people.”

Specifics of the Proposal

Section 1557 of the Affordable Care Act prohibits discrimination on the basis of race, color, national origin, sex, age, or disability. Any facility that delivers services while receiving federal funds (for example, Medicare and Medicaid) has to provide meaningful access to those services regardless of national origin.  In the case of those with limited English proficiency, this means providing qualified, professional interpretation and translation so all patients receive the same level of care.

Section 1557 requirements also apply to the Health Insurance Marketplaces. This means that participating plans must have language services like qualified interpreters and translated documents in place and readily available. Regulations also mandate that these plans provide translated notices and taglines (in the top 15 non-English languages in their state of operation) alerting limited-English customers to the language support that is available to them at no cost. Additionally, it requires a nondiscrimination clause and directions on how to file a complaint with the Office for Civil Rights.

As it relates to language, the Trump administration’s proposal would have four main impacts:

  1. Rolls back need for notices of language assistance: The proposed rule would repeal requirements on covered entities to mail beneficiaries and enrollees notices concerning non-discrimination and the availability of language services with every “significant” publication and communication larger than a postcard or brochure.
  2. Limits oversight of language-access plans: The proposed rule eliminates the requirement for the Office for Civil Rights to weigh the presence or absence of language-access plans.
  3. Reduces scope of who must comply with Section 1557: The proposed rule narrows the definition of covered entities. Health insurance programs administered by entities not principally engaged in providing health care will only have to abide the law to the extent those programs (as opposed to those entities) receive federal assistance.
  4. Eliminates current video remote interpreting standards: The proposed rule would only include standards for audio-only interpreting, which it views as sufficient and more cost effective.

What You Can Do

The public can submit comments on the proposed law via the Federal Register website through August 13.

The NHeLP and the Joint National Committee for Languages (JNCL) will host an educational webinar on Tuesday, July 9, at 1 p.m. ET/10 a.m. PT titled “The Trump Administration’s Proposed Changes to Languages Access in the Section 1557 Regulations.” Presenters will discuss the proposed changes and explain what you can do to get involved. We invite you to register here.

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