Association for Public Policy Analysis & Management

Language barriers continue to impact healthcare access for 25 million individuals with Limited English Language Proficiency (LEP) living in the United States.  In an effort to reduce communication barriers for individuals with LEP, the Affordable Care Act mandated that insurers provide specific healthcare documents in languages other than English.  The requirements for translated versions of the Summary of Benefits and Coverage, as well as the Universal Glossary, take effect for insurers in counties meeting specific demographic population requirements.  Specifically, if 10% of the population age 5 and older in a county cannot speak English, insurance carriers must provide translated documents.  Counties that come under this provision of the ACA are defined each year using the American Community Survey (ACS).

If the translation requirement of the ACA is having its intended effect, we suggest that LEP patients might be better able to take advantage of another ACA benefit--- zero cost sharing for preventive care.  In counties that are required to provide culturally and linguistically appropriate information, LEP individuals may understand their health care benefits better.  In particular, LEP individuals with access to translated documents might be more likely to know whether a particular visit should have an out-of-pocket obligation and, if so, how much it should be.  This may ultimately result in lower out-of-pocket costs for preventive care among LEP patients.    To investigate this possibility,  we compare out-of-pocket expenditures on preventive care among Latinos living in counties with and without translation requirements.   Two types of preventive care services that come under the ACA’s zero cost-sharing mandate are examined: well-child visits and screening mammography visits.      

We use data from the 2002-2013 household component of the Medical Expenditure Panel Survey.  Preliminary findings from an interrupted time series analysis of well child visits suggests that Latinos in  counties with translation requirements benefit from the ACA’s zero cost sharing mandate for preventive care more than Latinos living in other counties.  When the ACA's zero cost sharing mandate took effect in 2011, mean out-of-pocket payments for well child visits among Latinos living in counties with translation requirements were higher than those for Latinos living in other counties ($27 vs. $19).  By 2013, however, the typical well-child visit was only $3 among Latinos living in counties with translation requirements, compared to $11 among Latinos living in other counties.    Our initial results thus suggest that the ACA's zero-cost sharing provision for preventive care is far more effective when culturally and linguistically appropriate materials are made available to individuals with limited English proficiency.   Changes in insurance status over time were found for Asians and Latinos with LEP. Future analyses will also investigate the impact of translation services on OOP expenditures for mammograms and across the general LEP population defined by actual language ability (not ethnicity), which includes a large percentage of Chinese individuals.