Obamacare Rule Bridges Language Barriers For Patients In Texas, But Its Future Is Uncertain

May 23, 2017

Despite uncertainty about the future of the Affordable Care Act, there are still new parts of the law going into effect.

In fact, at the start of this year, a provision prohibiting discrimination on the basis of race, national origin, sex, age or disability in certain health programs or activities formally kicked in. In Texas, that has translated into a new standard for language-access programs across the state.

Marla Neriotrigueros recently had a baby at Seton Medical Center in Central Austin. The nurse manager on her floor, Linda Forster, had some questions about how she was doing, but Neriotrigueros doesn’t speak English very well, so Forster rolled in a medical cart with a little TV screen attached to it. Once it was turned on, she started asking questions.

“All right and what’s your pain level right now?” she asks.

A woman on the screen translates the question for Neriotrigueros and then translates her reply for Forster, who learns postpartum pain meds are helping.

It's similar to Skype or Facetime, except it’s over a secure line so the medical provider can discuss the patient's health.

It may seem like a small thing, but translation services in a situation like this can mean life or death.

Geronimo Rodriguez, chief advocacy officer for Ascension Texas (which encompasses Seton hospitals), says there were times when such services would have been helpful for his parents while he was growing up.

“I spoke Spanish at home and I learned English in school,” he said. “And so to me, I had the experience of going to doctors and health care entities [to interpret] for them."

Health care advocates have argued for years that interpretation services shouldn’t be left up to patients.

Laura Durso with the left-leaning Center for American Progress says requiring people who need medical care to provide their own translators is an unfair burden, and there’s evidence this leads to bad health outcomes.

“There’s a case of a young person named Griselda Zamora,” Durso said. “She was her family’s interpreter, but she got sick. She had severe abdominal pain and went to a hospital."

She was too sick to translate for her parents and the hospital didn't provide an interpreter, so her parents didn't understand that they should bring her back to the hospital if her symptoms worsened.

Griselda's symptoms did get worse, Durso says.

“She ended up with a ruptured appendix, and unfortunately died shortly after that happened," she said. "And so these are the types of cases that Section 1557 is really meant to prevent."

Section 1557 of the Affordable Care Act, is a part of the law, also known as Obamacare, that incorporates civil rights into the health care system.

"Since 1902, the Daughters of Charity have welcomed everyone no matter who they are, where they come from, what language they speak, or whether they can afford it or not."

Basically, it ensures that no matter your race, national origin, gender identity or sexual orientation, you will get the same standard of care in America. Depending where you live, this could mean big changes.

Rodriguez says that for Seton hospitals, though, it’s not a big change.

“Since 1902, the Daughters of Charity have welcomed everyone no matter who they are, where they come from, what language they speak, or whether they can afford it or not,” he said.

Rodriguez says that provision of the ACA, which formally went into effect in January, mostly just provided an opportunity for Seton to beef up existing programs.

He says Seton has been keeping a very close eye on demographics in the area. 

Right now, Rodriguez says, Seton has translation services available in 42 different languages. He says that’s not because of the law; it’s because in 2005 the Austin area became majority minority. Now almost a quarter of families here don’t speak English at home.

“Frankly in Central Texas, we talk about diversity but we are not as inclusive as we think we are,” he says. “And I think providing language services is one more way to be inclusive, to treat people with respect, to increase your bottom line, to grow your revenue.”

But not all hospitals in the country – or even in Texas – are working with this baseline.

Durso explains that in some cases hospitals aren’t entirely plugged into the specifics of the community they are serving.

“You may not know that you are serving people with low English proficiency, but likely they are in the community,” she says.

That’s why Durso says it’s good to have this in federal law. That way, even if hospitals don’t know who is in their service area, they will still have programs available when they are needed.

A provision in the Affordable Care Act kicked in in January that prohibits discrimination on the basis of race, national origin, sex, age or disability in certain health programs or activities.
Credit Gabriel Cristóver Pérez / KUT

Durso says she hopes this part of Obamacare sticks around. Other parts of the ACA – including Section 1557 – are already under siege.

For example, protections for some LGBT patients and women seeking abortions in Section 1557 are now exempt from the implementation of the provision, thanks to recent lawsuits from religious providers.

There’s also murkiness about whether language services could be undermined by the Trump administration – or specifically the secretary of Health and Human Services.

“The secretary has a really significant ability to undermine Section 1557 and what it is meant to do,” Durso said. “They certainly signaled that they will take another look at the rule, and we have grave concerns."